American Society of Hirudotherapy

Plasma exchange on venovenous extracorporeal membrane oxygenation with bivalirudin anticoagulation

Research article published in World journal for pediatric & congenital heart surgery (2015)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Case reportDrug DevelopmentPreston TJ et al. · World journal for pediatric & congenital heart surgery, 2015

Abstract

A pediatric patient requiring venovenous (VV) extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation developed heparin-induced thrombocytopenia. Unfractionated heparin was discontinued, and a bivalirudin infusion was started. During the lung transplant evaluation, he was found to have allosensitization, requiring treatment with plasma exchange along with pulse methylprednisolone, rituximab, bortezomib, and pooled immunoglobulin infusion. We describe our experience with successful plasma exchange for allosensitization during bivalirudin anticoagulation on VV ECMO in a pediatric patient.

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

Publication typeCase ReportsJournal Article
Indexed MeSH termsAntithrombinsExtracorporeal Membrane OxygenationFatal OutcomeHeparinHirudinsHumansInfantLung TransplantationMalePeptide FragmentsPlasma ExchangePreoperative Care

Summary

Plasma exchange on venovenous extracorporeal membrane oxygenation with bivalirudin anticoagulation.

Why This Matters for Hirudotherapy

This single-patient case report describes a pediatric patient on venovenous ECMO as a bridge to lung transplant who developed heparin-induced thrombocytopenia, was switched from unfractionated heparin to a bivalirudin infusion, and then underwent successful plasma exchange (alongside immunosuppressive therapy) for allosensitization while anticoagulated with bivalirudin. For hirudotherapy the connection is mechanistic: bivalirudin is a direct thrombin inhibitor in the same pharmacologic lineage as leech-derived hirudin, illustrating the clinical niche, such as heparin-induced thrombocytopenia, where direct thrombin inhibition derived from the leech-secretome story becomes valuable. The strong caveat is that this is a single anecdotal case with no medicinal leech or hirudin involvement; it cannot establish efficacy or safety and serves only as illustrative context for the direct-thrombin-inhibitor class.

Citation

Plasma exchange on venovenous extracorporeal membrane oxygenation with bivalirudin anticoagulation

Preston TJ et al. · World journal for pediatric & congenital heart surgery, 2015

DOI

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

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