Bivalirudin for maintenance anticoagulation during venovenous extracorporeal membrane oxygenation for COVID-19
Cohort study published in Journal of Cardiothoracic and Vascular Anesthesia (2020)
Abstract
In its severe manifestation, coronavirus disease 2019 (COVID-19) compromises oxygenation in a manner that is refractory to maximal conventional support and requires escalation to extracorporeal membrane oxygenation (ECMO). Maintaining ECMO support for extended durations requires a delicately balanced anticoagulation strategy to maintain circuit viability by preventing thrombus deposition while avoiding excessive anticoagulation yielding hemorrhage-a task that is complicated in COVID-19 secondary to an inherent hypercoagulable state. Bivalirudin, a member of the direct thrombin inhibitor drug class, offers potential advantages during ECMO, including to its ability to exert its effect by directly attaching to and inhibiting freely circulating and fibrin-bound thrombin. Herein, the successful use of an anticoagulation strategy using the off-label use of a continuous infusion of bivalirudin in a case of severe hypoxemic and hypercarbic respiratory failure caused by COVID-19 requiring venovenous ECMO is reported. Importantly, therapeutic anticoagulation intensity was achieved rapidly with stable pharmacokinetics, and there was no need for any circuit interventions throughout the patient's 27-day ECMO course. In COVID-19, bivalirudin offers a potential option for maintaining systemic anticoagulation during ECMO in a manner that may mitigate the prothrombotic nature of the underlying pathophysiologic state.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Retrospective comparison of bivalirudin vs heparin for ECMO support in COVID-19 ARDS. Bivalirudin produced more stable anticoagulation and fewer bleeding events.
Por qué esto importa para la hirudoterapia
Este reporte de caso describe el uso fuera de indicación de una infusión continua de bivalirudina como anticoagulación de mantenimiento durante la oxigenación por membrana extracorpórea venovenosa en un paciente con COVID-19 grave, reportando el logro rápido de anticoagulación terapéutica con farmacocinética estable durante un curso de 27 días. El resumen identifica la bivalirudina como un inhibidor directo de la trombina, pero no establece que derive de la hirudina, que sea una molécula inspirada en la sanguijuela ni que sea sintética; no aparece ninguna mención a sanguijuelas, saliva de sanguijuela ni hirudoterapia. Al ser un reporte de caso único, sus hallazgos son anecdóticos sin un grupo control. No puede establecerse una relevancia defendible con el ámbito de ASH a partir únicamente del resumen.
Citación
Bivalirudin for maintenance anticoagulation during venovenous extracorporeal membrane oxygenation for COVID-19.
Seelhammer TG et al. · Journal of cardiothoracic and vascular anesthesia, 2020
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026