American Society of Hirudotherapy

Bivalirudin in pediatric extracorporeal membrane oxygenation

Research article published in Current opinion in pediatrics (2022)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Narrative reviewDrug DevelopmentRyerson LM et al. · Current opinion in pediatrics, 2022

Abstract

PURPOSE OF REVIEW: This review summarizes the current literature surrounding the use of bivalirudin as an alternative anticoagulant for pediatric extracorporeal membrane oxygenation (ECMO) patients. RECENT FINDINGS: Recent single center studies describe that bivalirudin may be associated with decreased blood product transfusion, decreased cost and similar clinical outcomes for pediatric ECMO patients who have failed unfractionated heparin (UFH) anticoagulation. aPTT is the most common test to monitor bivalirudin but has several limitations. Other tests including dilute thrombin time (dTT) and viscoelastic assays are promising but more study is needed. Current evidence suggests that bivalirudin is a well tolerated and effective alternative anticoagulant for pediatric ECMO patients who have failed UFH anticoagulation but prospective studies are needed to confirm these results. SUMMARY: Bivalirudin is a promising alternative anticoagulant for pediatric ECMO patients who have failed UFH. Large prospective, multicenter studies are needed to confirm safety and efficacy.

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

Publication typeJournal ArticleReview
Indexed MeSH termsAnticoagulantsChildExtracorporeal Membrane OxygenationHeparinHirudinsHumansPeptide FragmentsProspective StudiesRecombinant Proteins

Summary

Bivalirudin in pediatric extracorporeal membrane oxygenation.

Why This Matters for Hirudotherapy

This narrative review summarizes current literature on bivalirudin as an alternative anticoagulant for pediatric ECMO patients, particularly those who have failed unfractionated heparin. Single-center studies suggest bivalirudin may be associated with decreased blood product transfusion, lower cost, and similar clinical outcomes, though monitoring challenges persist (aPTT limitations; dilute thrombin time and viscoelastic assays are promising but need more study). The review concludes that bivalirudin is a promising alternative but that large prospective multicenter studies are needed. For ASH, this is relevant because bivalirudin is a synthetic derivative of hirudin from medicinal leech saliva, and its expanding pediatric use exemplifies clinical translation of leech-secretome anticoagulant principles. However, this is a review of a pharmaceutical agent, not leech therapy or leech extract, and the underlying evidence base consists primarily of small single-center studies.

Citation

Bivalirudin in pediatric extracorporeal membrane oxygenation

Ryerson LM et al. · Current opinion in pediatrics, 2022

DOI

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

This website provides educational information and does not constitute medical advice, diagnosis, or treatment recommendations. Medicinal leech therapy carries clinically meaningful risks and should be performed only by qualified clinicians under institutionally approved protocols. FDA 510(k) clearance for medicinal leeches is limited to specific indications; investigational and off-label discussions are labeled accordingly. For patient-specific guidance, consult a qualified healthcare provider.