Evaluation of Intraoperative Bivalirudin Anticoagulation in Neonates and Infants Undergoing Arterial Switch Operation on Integrated ECMO-CPB Circuit: A Prospective Study
Research article published in Journal of cardiothoracic and vascular anesthesia (2025)
Abstract
OBJECTIVES: To ascertain the dosage of bivalirudin in neonates and infants undergoing arterial switch operation on integrated extracorporeal membrane oxygenation-cardiopulmonary bypass (CPB) circuit. DESIGN: Pilot study. SETTING: A tertiary care hospital. PARTICIPANTS: Ten neonates and infants with transposition of great arteries undergoing an arterial switch operation INTERVENTIONS: The patients received a bivalirudin bolus dose of 1 mg/kg followed by a maintenance dose of 2.5 mg/kg/h. The infusion dose was adjusted to maintain an activated clotting time (ACT) >480 s. MEASUREMENTS AND MAIN RESULTS: The mean age and weight were 92 ± 67 days and 4.1 ± 1.45 kg, respectively. There were more male children than female (8:2). The mean baseline ACT score was 207.6 ± 52.4 s. The bolus dose required was 1 mg/kg, and two children required an additional bolus dose of 0.5 mg/kg. The mean ACT of the priming solution was 999 s, and the mean ACT following the bolus dose was 575.9 ± 101 s. The maintenance dose required was 2.1 ± 0.3 mg/kg/h. The mean ACT on CPB after 30 min, 60 min, and 90 min was 956.2 ± 62.8 s, 936.8 ± 137 s, and 829.6 ± 232.5 s, respectively. There was no incidence of clot formation in the circuit or thromboembolic complications. CONCLUSIONS: Bivalirudin can be effectively used for anticoagulation during CPB in neonates and infants with transposition of great arteries, at a bolus dose of 1 mg/kg and a maintenance dose of 2.1 ± 0.3 mg/kg/h, utilizing the integrated extracorporeal membrane oxygenation-CPB circuit.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Evaluation of Intraoperative Bivalirudin Anticoagulation in Neonates and Infants Undergoing Arterial Switch Operation on Integrated ECMO-CPB Circuit: A Prospective Study.
Por qué esto importa para la hirudoterapia
Este estudio piloto evaluó la anticoagulación intraoperatoria con bivalirudina en 10 neonatos y lactantes sometidos a operación de switch arterial para transposición de grandes arterias utilizando un circuito integrado de ECMO-CPB. El estudio encontró que una dosis de carga de 1 mg/kg seguida de una dosis de mantenimiento de 2,1 ± 0,3 mg/kg/h mantuvo el TCA por encima de 480 segundos, sin formación de coágulos en el circuito ni complicaciones tromboembólicas. El resumen no menciona hirudina, sanguijuelas ni ningún producto derivado de sanguijuelas, por lo que no puede establecerse una conexión defendible con el dominio de la hirudoterapia de la ASH o el secretoma de la sanguijuela a partir de esta fuente. Al tratarse de un estudio piloto de pequeño tamaño, los hallazgos son exploratorios y los autores no reivindican una eficacia definitiva.
Citación
Evaluation of Intraoperative Bivalirudin Anticoagulation in Neonates and Infants Undergoing Arterial Switch Operation on Integrated ECMO-CPB Circuit: A Prospective Study
Badge HM et al. · Journal of cardiothoracic and vascular anesthesia, 2025
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026