Bleeding Complications between Bivalirudin and Heparin for Extracorporeal Membrane Oxygenation in Neonates with Congenital Diaphragmatic Hernia.
Research article published in Fetal diagnosis and therapy (2024)
Abstract
INTRODUCTION: Neonates with congenital diaphragmatic hernia (CDH) who undergo repair while on extracorporeal membrane oxygenation (ECMO) are at risk of developing post-operative bleeding complications. Balanced anticoagulation is critical to maintain ECMO flow and avoid bleeding. Heparin has historically been our first-line anticoagulant; however, recently, we transitioned to bivalirudin, a direct thrombin inhibitor. The objective of this pilot study was to compare post-operative surgical bleeding complications between the two groups. METHODS: We performed a single center retrospective cohort study of patients who underwent CDH repair while on ECMO between 2008 and 2023. Neonates were stratified based on the type of anticoagulant initiated after CDH repair. Outcomes included bleeding requiring surgical re-operation, intracranial hemorrhage, volume of blood products transfused, number of circuit changes, days on ECMO, and overall survival. RESULTS: Among 62 neonates with CDH who underwent repair on ECMO, 44 (71%) were managed post-CDH repair with heparin and 18 (29%) with bivalirudin. One (5.6%) neonate managed with bivalirudin underwent re-operation following CDH repair for a bleeding complication compared to 17 (38.6%) managed with heparin (p = 0.022). In addition, the bivalirudin cohort utilized half of the total blood product volume compared to the heparin cohort (p = 0.020). Despite these benefits, there were no significant differences between groups for incidence of intracranial hemorrhage, number of circuit changes, days on ECMO, and overall survival. CONCLUSION: Anticoagulation with bivalirudin in neonates who underwent CDH repair while on ECMO was associated with decreased surgical bleeding complications and less total blood product transfused. This pilot analysis is the first to compare heparin to bivalirudin and stresses the importance of a multicenter study.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Neonates with congenital diaphragmatic hernia (CDH) who undergo repair while on extracorporeal membrane oxygenation (ECMO) are at risk of developing post-operative bleeding complications. Balanced anticoagulation is critical to maintain ECMO flow and avoid bleeding.
Por qué esto importa para la hirudoterapia
This single-center retrospective cohort study compared post-operative surgical bleeding complications between heparin (n=44) and bivalirudin (n=18) anticoagulation in 62 neonates with congenital diaphragmatic hernia who underwent repair while on ECMO (2008–2023). Bivalirudin was associated with significantly fewer re-operations for bleeding (5.6% vs. 38.6%, p=0.022) and approximately half the total blood product transfusion volume (p=0.020), with no significant differences in intracranial hemorrhage, circuit changes, ECMO duration, or survival. The abstract identifies bivalirudin only as a direct thrombin inhibitor and makes no reference to hirudin, leeches, or leech-derived compounds; any connection to ASH's domain is indirect at best. Caveat: This is a pilot analysis at a single center with a modest bivalirudin cohort, and the authors emphasize the need for multicenter confirmation.
Citación
Bleeding Complications between Bivalirudin and Heparin for Extracorporeal Membrane Oxygenation in Neonates with Congenital Diaphragmatic Hernia.
Credille et al. · Fetal diagnosis and therapy, 2024
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Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: June 18, 2026