Heparin versus bivalirudin for anticoagulation in adult extracorporeal membrane oxygenation: a systematic review and meta-analysis
Systematic review and meta-analysis published in ASAIO Journal (2023)
Abstract
Extracorporeal membrane oxygenation (ECMO) poses unique thrombotic and hemorrhagic risks, and the optimal anticoagulant choice is unknown. We systematically searched Ovid EBM Reviews, Ovid Embase, Ovid Medline, Scopus, and Web of Science Core Collection for randomized-, crossover-, retrospective cohort-, or parallel-designed clinical studies of adult patients receiving ECMO that compared heparin recipients with bivalirudin recipients. Meta-analysis was performed with random-effects models. The ROBINS-I tool was used to assess the risk of bias. Six retrospective observational studies met the inclusion criteria for the qualitative summary. Five studies were suitable for meta-analysis. Those who received heparin were more likely to experience circuit-related thrombosis (odds ratio [OR] 2.05, 95% confidence interval [CI] 1.25-3.37, p = 0.005, I2 = 0%) and die (OR 1.62, 95% CI 1.19-2.21, p = 0.002, I2 = 0%) compared with those who received bivalirudin. There were no differences in major bleeding events between heparin and bivalirudin recipients (OR 1.83, 95% CI 0.55-6.09, p = 0.33, I2 = 82.7%). In retrospective settings compared with heparin anticoagulation, bivalirudin was associated with less circuit-related thrombotic events and greater survival in adults supported on ECMO, without contributing to more bleeding complications. Prospective controlled studies comparing heparin and bivalirudin in adult ECMO patients are warranted to corroborate these findings.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Systematic review of retrospective studies in adult ECMO found bivalirudin recipients had lower odds of circuit-related thrombosis (OR 2.05 for heparin) and death (OR 1.62) than heparin recipients, with no significant difference in major bleeding events between the groups.
Why This Matters for Hirudotherapy
This systematic review and meta-analysis compared heparin versus bivalirudin anticoagulation in adult patients receiving extracorporeal membrane oxygenation, pooling data from six retrospective observational studies (five suitable for meta-analysis). Patients receiving heparin were significantly more likely to experience circuit-related thrombosis and death compared to bivalirudin recipients, with no significant difference in major bleeding events between groups. Bivalirudin (formerly Hirulog) is a synthetic peptide anticoagulant designed partly on the C-terminal sequence of hirudin, the anticoagulant of the medicinal leech (Maraganore et al., 1990); this paper studies the drug, not leech therapy. The evidence base is entirely retrospective and observational, and the study involves a pharmaceutical anticoagulant in critical care.
Citation
Reference (Vancouver style)
Wieruszewski PM, Macielak SA, Nei SD, Moman RN, Seelhammer TG, Nabzdyk CGS, et al. Heparin versus bivalirudin for anticoagulation in adult extracorporeal membrane oxygenation: a systematic review and meta-analysis. ASAIO J. 2023;69(2):137-144. doi:10.1097/MAT.0000000000001808. PMID: 36355803
Bibliographic details (authors, volume, pages, DOI) are taken from the PubMed record.
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