Multicenter Registry Analysis of Bivalirudin for Primary Anticoagulation in Pediatric HeartMate 3 Recipients: ACTION Analysis

Bivalirudin, a direct thrombin inhibitor, is increasingly used as an alternative to heparin in pediatric mechanical circulatory support (MCS) and has resulted in improved stroke-free survival in children supported by paracorporeal pulsatile devices. However, for those supported by implanted continuous-flow devices, such as HeartMate 3, significant practice variation exists in agents used as early intravenous anticoagulation. Leveraging ACTION VAD registry data, we sought to compare early hemocompatibility-related adverse events (<14 days) in pediatric HeartMate 3 patients on bivalirudin versus heparin (unfractionated heparin [UFH]). A total of 234 patients, aged under 25 years, with a median age of 15 years and a median weight of 60 kg, at the time of HeartMate 3 implant, were included in the study cohort. Of these, 100 (42.7%) received bivalirudin as initial intravenous anticoagulation agent and 134 (57.2%) received UFH. With data censored at change of agent, there was no significant difference between the groups for freedom from stroke (96.9% vs. 96.3%, p = 0.77) or bleeding (94.8% vs. 89.9% %, p = 0.21), but time to transition to oral anticoagulation was longer for the bivalirudin group. Survival at 1 year after implant was also not different between groups. These data suggest that bivalirudin is a reasonable alternative to UFH for early thromboprophylaxis after HeartMate 3 implantation.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

ACTION registry analysis of 234 pediatric HeartMate 3 implants showed no significant difference between bivalirudin (42.7%) and heparin (57.2%) groups for freedom from stroke or bleeding, supporting bivalirudin as a reasonable alternative for early thromboprophylaxis.

Leech-derived molecules this paper discusses, each with a full profile in the ASH compound registry:

Erfahren Sie, wie diese Forschung mit der klinischen Praxis verknüpft ist

More peer-reviewed studies in Klinische Studien.

• Leech Therapy for Knee Osteoarthritis — The Landmark RCT — Michalsen et al. (2003)
• Leech-Assisted Flap Salvage — Systematic Review of 277 Cases — Whitaker et al. (2012)
• Effects of hirudotherapy on liver functions, lipid profile, and insulin sensitivity in rats with metabolic syndrome — Bilden A et al. (2026)
• Efficacy and Safety of Hirudotherapy for Improving Sperm Quality Parameters in Male Infertility: A Randomized Controlled Trial — Abtahi-Forooshani M et al. (2026)
• Reverse Sural Flap Venous Congestion Successfully Managed With Enoxaparin in a Male Patient With a Traumatic Foot Crush Injury: A Case Report — Velasco-Bustamante J et al. (2026)
• Investigation of the therapeutic effects of medicinal leech treatment on lower extremity ischemia-reperfusion injury — Ünal K et al. (2026)
• Efficacy of Medicinal Leech Therapy in Diverse Clinical Applications: A Comprehensive Study from Azerbaijan — Farzali S et al. (2025)
• HIRUDOTHERAPY IN RECONSTRUCTIVE SURGERY: CASE-REPORTS AND REVIEW — Heinz P et al. (2020)
• Hirudotherapy Efficacy and Complications in the Management of Microsurgical Breast Reconstruction: A Systematic Review — Foppiani J et al. (2024)
• Hirudotherapy in Wound Healing — Nair H et al. (2022)

Browse all ASH-analysed research →