Bivalirudin May Reduce the Need for Red Blood Cell Transfusion in Pediatric Cardiac Patients on Extracorporeal Membrane Oxygenation
Retrospective study published in ASAIO J (2021)
Abstract
We retrospectively compared anticoagulation with heparin and bivalirudin for 32 consecutive children under 18 years old during extracorporeal membrane oxygenation (ECMO) in our pediatric cardiac intensive care unit (PCICU). Between September 2015 and January 2018, 14 patients received heparin, 13 venoarterial (VA), and 1 venovenous (VV). From February 2018 to September 2019, 18 received bivalirudin (all VA). The mean (standard deviation [SD]) percentage of time with therapeutic activated partial thromboplastin time and activated clotting time was bivalirudin 54 (14%) and heparin 57 (11%), p = 0.4647, and percentage of time supratherapeutic was bivalirudin 18 (10%) and heparin 27 (12%), p = 0.0238. Phlebotomy-associated blood loss per hour of ECMO was double in the heparin compared with bivalirudin group 1.08 ml/h (0.20 ml/h), compared with 0.51 ml/h (0.07 ml/h), p = 0.0003, as well as interventions to control bleeding. Packed red blood cell (PRBC) transfusions significantly correlated with higher blood loss in the heparin group (Pearson correlation coefficient = 0.49, p = 0.0047). Overall amount of blood product utilization was not different between the groups. Survival to ECMO decannulation was 89% for bivalirudin and 57% for heparin, p = 0.0396, although 6 month survival was not significantly different (67% versus 57%, p = 0.5809). Heparin may increase the need for PRBC transfusions and strategies to attenuate bleeding when compared with bivalirudin for children receiving ECMO in PCICU.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Bivalirudin had half the phlebotomy-associated blood loss versus heparin (0.51 vs 1.08 mL/h, p=0.0003) and 89% versus 57% ECMO decannulation survival (p=0.0396).
Why This Matters for Hirudotherapy
This retrospective study compared anticoagulation outcomes between heparin (14 patients) and bivalirudin (18 patients) in 32 consecutive children under 18 on ECMO in a pediatric cardiac intensive care unit between 2015 and 2019. The authors found that the bivalirudin group spent significantly less time in the supratherapeutic range (18% vs 27%, p = 0.0238), had significantly lower phlebotomy-associated blood loss per hour (0.51 mL/h vs 1.08 mL/h, p = 0.0003), and showed higher survival to ECMO decannulation (89% vs 57%, p = 0.0396), though six-month survival did not differ significantly. The abstract does not mention hirudin, leeches, or any leech-derived compound, so no defensible hirudotherapy link exists. This is a single-center retrospective study with small, temporally allocated groups, does not involve leeches or hirudotherapy, and overall blood product utilization did not differ between groups.
Citation
Bivalirudin May Reduce the Need for Red Blood Cell Transfusion in Pediatric Cardiac Patients on Extracorporeal Membrane Oxygenation.
Machado DS et al. · ASAIO journal, 2021
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