Extracorporeal Membrane Oxygenation Complications in Heparin- and Bivalirudin-Treated Patients.
Research article published in Critical care explorations (2021)
Abstract
UNLABELLED: Extracorporeal membrane oxygenation is a potentially life-saving intervention in refractory cardiopulmonary failure, but it requires anticoagulation to prevent circuit thromboses, which exposes the patient to hemorrhagic complications. Heparin has traditionally been the anticoagulant of choice, but the direct thrombin inhibitor bivalirudin is routinely used in cases of heparin-induced thrombocytopenia and has been suggested as a superior choice. We sought to examine the timing of hemorrhagic and thrombotic complications after extracorporeal membrane oxygenation cannulation and to compare the rates of such complications between patients anticoagulated with heparin versus bivalirudin. DESIGN: Retrospective cohort study. SETTING: Johns Hopkins Hospital patients between January 2016 and July 2019. PATIENTS: Adult (> 18 yr) extracorporeal membrane oxygenation patients. INTERVENTIONS: Patients were anticoagulated either with heparin or bivalirudin. MEASUREMENTS AND MAIN RESULTS: We compared rates of hemorrhagic and thrombotic complications by time on heparin versus bivalirudin and characterized the average time to each complication. Of 144 extracorporeal membrane oxygenation patients (mean age 55.3 yr; 58% male), 41% were on central venoarterial extracorporeal membrane oxygenation, 40% on peripheral venoarterial extracorporeal membrane oxygenation, and 19% on venovenous extracorporeal membrane oxygenation. Thirteen patients (9%) received bivalirudin during their extracorporeal membrane oxygenation run, due to concern for (n = 8) or diagnosis of (n = 4) heparin-induced thrombocytopenia or for heparin resistance (n = 1). The rate of hemorrhagic or thrombotic complications did not differ between heparin (0.13/d) and bivalirudin (0.06/d; p = 0.633), but patients on bivalirudin received significantly fewer blood transfusions (1.0 U of RBCs/d vs 2.9/d on heparin; p < 0.001). CONCLUSIONS: Our results confirm the safety and efficacy of bivalirudin as an alternative anticoagulant in extracorporeal membrane oxygenation and suggest a potential benefit in less blood product transfusion, although prospective studies are needed to evaluate the true effect of bivalirudin versus the disease processes that prompted its use in our study population.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Extracorporeal membrane oxygenation is a potentially life-saving intervention in refractory cardiopulmonary failure, but it requires anticoagulation to prevent circuit thromboses, which exposes the patient to hemorrhagic complications. Heparin has traditionally been the anticoagulant of choice, but...
Why This Matters for Hirudotherapy
This retrospective cohort study examined timing and rates of hemorrhagic and thrombotic complications in 144 adult ECMO patients anticoagulated with either heparin or bivalirudin at Johns Hopkins Hospital (January 2016–July 2019). No significant difference in daily complication rates was observed between heparin (0.13/d) and bivalirudin (0.06/d; p=0.633), though patients on bivalirudin received significantly fewer red blood cell transfusions (1.0 U/d vs. 2.9/d; p<0.001). This study has no defensible connection to hirudotherapy, leech therapy, or the leech secretome: the abstract identifies bivalirudin solely as a direct thrombin inhibitor and makes no reference to hirudin, leeches, or leech-derived compounds. Caveat: The small bivalirudin subgroup (n=13) limits comparative strength, and the authors call for prospective studies.
Citation
Extracorporeal Membrane Oxygenation Complications in Heparin- and Bivalirudin-Treated Patients.
Giuliano et al. · Critical care explorations, 2021
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