Retrospective, Single-Center Cohort Study of Bivalirudin Compared to Unfractionated Heparin in Patients Receiving Extracorporeal Membrane Oxygenation

BACKGROUND: Extracorporeal membrane oxygenation (ECMO), a form of temporary mechanical circulatory support, causes a prothrombotic state due to activation of inflammatory processes via exposure of blood to the circuit. Systemic anticoagulation is recommended to prevent thrombosis. Unfractionated heparin (UFH) and direct thrombin inhibitors (DTIs) are anticoagulant agents that inactivate thrombin; however, UFH requires antithrombin III (ATIII) for its activity, and patients supported by ECMO are at risk for acquired ATIII deficiency. In addition, heparin may cause heparin-induced thrombocytopenia, complicating therapy. Guidelines on anticoagulant use in ECMO reference UFH as a recommended agent with DTIs as an alternative option. Meta-analyses comparing the 2 agents in ECMO have evaluated efficacy and safety; however, discordant results prompt the need for additional research. OBJECTIVE: The objective of this study is to evaluate differences in bleeding and thrombotic events between UFH and bivalirudin for anticoagulation during ECMO support. METHODS: This study is a retrospective, single-center cohort study conducted at a primary ECMO center and a tertiary academic medical center. RESULTS: Bleeding and systemic thrombosis rates were not different between bivalirudin and UFH (30 vs 33 events, hazard ratio [HR] = 0.89; 95% confidence interval [CI] = 0.55-1.47, P = 0.7; 12 vs 17 events, HR = 0.68; 95% CI = 0.32-1.42, P = 0.3); however, when controlled for covariates, device thrombosis was lower with bivalirudin (30.2% vs 43.4%, P = 0.017). Time in therapeutic range (TTR) was higher with bivalirudin (69.98% vs 55.5%, P < 0.001). CONCLUSION AND RELEVANCE: When compared to heparin, bivalirudin for anticoagulation in ECMO was associated with a decreased rate of device thrombosis and greater TTR.

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

Single-center retrospective cohort comparing bivalirudin to unfractionated heparin for anticoagulation during extracorporeal membrane oxygenation (ECMO). Documents bleeding, thrombotic events, and circuit complications.

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 Arzneimittelentwicklung.

• Novel Leech Antimicrobial Peptides — Hirunipins — Kumar et al. (2025)
• Medicinal Leech Genome Assembly — Anticoagulant Gene Catalog — Kvist et al. (2020)
• Effects of hirudotherapy on liver functions, lipid profile, and insulin sensitivity in rats with metabolic syndrome — Bilden A et al. (2026)
• Hirudotherapy in Medicine and Dentistry — Jha K et al. (2015)
• Medicinal leech therapy (hirudotherapy): a brief overview — Singh A (2010)
• HIRUDOTHERAPY IN PRESBYACUZIS PRAECOX IN CLEAN-UP WORKERS AFTER THE CHORNOBYL ACCIDENT DURING THE POST-CATASTROPHE YEARS — Zabolotnyi D, Mishchanchuk N (2019)
• Investigation of oxidant-antioxidant status in patients treated with hirudotherapy: an experimental study — Sarikan I, Savas H (2024)
• Leech therapeutic applications — Abdualkader A et al. (2013)
• Non-Occlusive Mesenteric Ischemia Due to Hirudotherapy: A Case Report — Akalın Ç, Ekmen N (2020)
• Leech therapy: a history — Hyson J (2005)

Browse all ASH-analysed research →