Comparison of bleeding and thrombotic outcomes in veno-venous extracorporeal membrane oxygenation: Heparin versus bivalirudin
Research article published in European journal of haematology (2024)
Abstract
OBJECTIVES: We aimed to evaluate thrombotic and hemorrhagic complications with heparin versus bivalirudin use in veno-venous extracorporeal membrane oxygenation (V-V ECMO). METHODS: We performed a retrospective cohort study of adult patients placed on V-V ECMO with intravenous anticoagulation with either heparin or bivalirudin. Time to thrombotic event and major bleed were analyzed in addition to related outcomes. RESULTS: We identified 95 patients placed on V-V ECMO: 61 receiving heparin, 34 bivalirudin. The bivalirudin group had a higher rate of severe COVID-19, higher BMI, and longer ECMO duration. Despite this, bivalirudin was associated with reduced risk of thrombotic event (HR 0.14, 95% CI 0.06-0.32, p < .001) and increased average lifespan of the circuit membrane lung (16 vs. 10 days, p = 0.004). While there was no difference in major bleeding, the bivalirudin group required fewer transfusions of packed red blood cells and platelets per 100 ECMO days (means of 13 vs. 39, p = 0.004; 5 vs. 19, p = .014, respectively). Lastly, the bivalirudin group had improved survival to ECMO decannulation in univariate analysis (median OS 53 vs. 26 days, p = .015). CONCLUSIONS: In this real-world analysis of bivalirudin versus heparin, bivalirudin is a viable option for V-V ECMO and associated with lower risk of thrombotic complications and fewer transfusion requirements.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Peer-reviewed pharmacology and drug-development research relevant to anticoagulants and leech-derived compounds. Indexed in PubMed and verified against the NCBI record.
Why This Matters for Hirudotherapy
This retrospective cohort study of 95 adults on veno-venous ECMO compared anticoagulation with heparin (n=61) versus bivalirudin (n=34) and found bivalirudin associated with a markedly lower risk of thrombotic events (HR 0.14, 95% CI 0.06-0.32), longer membrane-lung circuit lifespan, and fewer transfusions, with no difference in major bleeding. The hirudotherapy connection runs through bivalirudin, a synthetic direct thrombin inhibitor whose design lineage traces back to hirudin, the anticoagulant peptide of the medicinal leech secretome; studies like this illustrate how leech-derived thrombin-inhibition pharmacology has matured into mainstream parenteral anticoagulants that compete clinically with heparin. As an honest caveat, this is a single-center retrospective cohort with imbalanced, modest-sized groups (the bivalirudin arm differed in COVID-19 severity, BMI, and ECMO duration), so it supports bivalirudin as a viable option rather than proving superiority, and it concerns a manufactured drug, not leech therapy or whole-leech secretome.
Citation
Comparison of bleeding and thrombotic outcomes in veno-venous extracorporeal membrane oxygenation: Heparin versus bivalirudin.
Kartika et al. · European journal of haematology, 2024
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