American Society of Hirudotherapy

The Changing Landscape of Anticoagulation in Pediatric Extracorporeal Membrane Oxygenation: Use of the Direct Thrombin Inhibitors

Research article published in Frontiers in medicine (2022)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Narrative reviewDrug DevelopmentNeunert C et al. · Frontiers in medicine, 2022

Abstract

Bleeding and thrombosis frequently occur in pediatric patients with extracorporeal membrane oxygenation (ECMO) therapy. Until now, most patients are anticoagulated with unfractionated heparin (UFH). However, heparin has many disadvantages, such as binding to other plasma proteins and endothelial cells in addition to antithrombin, causing an unpredictable response, challenging monitoring, development of heparin resistance, and risk of heparin-induced thrombocytopenia (HIT). Direct thrombin inhibitors (DTIs), such as bivalirudin and argatroban, might be a good alternative. This review will discuss the use of both UFH and DTIs in pediatric patients with ECMO therapy.

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

Publication typeJournal ArticleReview

Summary

The Changing Landscape of Anticoagulation in Pediatric Extracorporeal Membrane Oxygenation: Use of the Direct Thrombin Inhibitors.

Why This Matters for Hirudotherapy

This review examines anticoagulation strategies in pediatric ECMO, discussing the disadvantages of unfractionated heparin (UFH)—including unpredictable response, heparin resistance, and risk of heparin-induced thrombocytopenia (HIT)—and the potential of direct thrombin inhibitors (DTIs) such as bivalirudin and argatroban as alternatives. No defensible connection to hirudotherapy or the leech secretome exists from this abstract, which does not mention leeches, hirudin, or any leech-derived substances at any point. The article is concerned entirely with pharmaceutical anticoagulants in a specialized critical care context, and relevance to ASH's domain is absent based solely on the abstract provided.

Citation

The Changing Landscape of Anticoagulation in Pediatric Extracorporeal Membrane Oxygenation: Use of the Direct Thrombin Inhibitors

Neunert C et al. · Frontiers in medicine, 2022

DOI

Added to ASH library: May 27, 2026 · Site last updated: June 18, 2026

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