Dosing Reliability of Direct Thrombin Inhibitors in Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis
Meta-analysis published in ASAIO journal (American Society for Artificial Internal Organs : 1992) (2025)
Abstract
Empirical evidence suggests direct thrombin inhibitors (DTIs) produce more favorable hemostatic outcomes than heparin in patients supported by extracorporeal membrane oxygenation (ECMO), yet the exact mechanisms responsible are unknown. We systematically searched databases and registers for studies comparing DTIs to heparin in humans receiving ECMO. A total of 28 studies were identified, most of which (n = 25) used bivalirudin, while the rest (n = 3) used argatroban. In random-effects meta-analysis, DTIs achieved the therapeutic anticoagulation range faster (mean difference = -6.96 hours, 95% confidence interval [CI] = -11.98 to -1.95, p = 0.006) and maintained the therapeutic range for a greater proportion of time (mean difference = 18.6%, 95% CI = 8.78-28.42, p < 0.001) than heparin. Subgroup analysis revealed these effects were similarly significant in adult patients and when bivalirudin was the DTI; however, they were not significant in pediatric patients or when argatroban was the DTI. Sensitivity analysis confirmed robustness of the primary findings in only low-risk of bias studies and in only studies published as full papers. In summary, DTIs-specifically bivalirudin-were associated with faster time to therapeutic anticoagulation and maintained the goal range for a greater percentage of time than heparin during ECMO support.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Zusammenfassung
Empirical evidence suggests direct thrombin inhibitors (DTIs) produce more favorable hemostatic outcomes than heparin in patients supported by extracorporeal membrane oxygenation (ECMO), yet the exact mechanisms responsible are unknown.
Warum dies für die Hirudotherapie relevant ist
This systematic review and meta-analysis identified 28 studies comparing direct thrombin inhibitors (DTIs) with heparin for anticoagulation during extracorporeal membrane oxygenation, finding that DTIs—predominantly bivalirudin (25 studies), with argatroban in 3—achieved therapeutic anticoagulation faster and maintained it for a greater proportion of time than heparin. Subgroup analyses showed significance in adults and with bivalirudin but not in pediatric patients or with argatroban. The abstract does not mention hirudin, leeches, or any leech-derived agents, so a defensible connection to hirudotherapy or the leech secretome cannot be made from the article itself; any such link would be external knowledge. Relevance to ASH is therefore not established by this abstract.
Zitation
Dosing Reliability of Direct Thrombin Inhibitors in Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis
Wieruszewski PM et al. · ASAIO journal (American Society for Artificial Internal Organs : 1992), 2025
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