Anticoagulation with Intravenous Direct Thrombin Inhibitors in Pediatric Extracorporeal Membrane Oxygenation: A Systematic Review of the Literature
Systematic review published in Semin Thromb Hemost (2023)
Abstract
Although intravenous (IV) direct thrombin inhibitors (DTI) have gained interest in pediatric extracorporeal membrane oxygenation (ECMO), dosing and safety information is limited. The objective of this systematic review was to characterize DTI types, dosing, monitoring, and outcomes (bleeding and thromboembolic) in pediatric ECMO patients managed with IV DTIs. We conducted searches of MEDLINE (Ovid) and Embase (Elsevier) from inception through December 2022. Case reports, retrospective studies, and prospective studies providing per-patients or summary data for patient(s) <18 years of age receiving IV DTI for ECMO anticoagulation were included. Study selection and data extraction were conducted independently by two reviewers. A total of 28 studies: 14 case reports, 13 retrospective studies, and 1 prospective study were included, totaling 329 patients. Bivalirudin was utilized in 318 (96.7%), argatroban in 9 (2.7%), and lepirudin in 2 (0.6%) patients. Infusion dosing included: bivalirudin 0.14 ± 0.37 mg/kg/h, argatroban 0.69 ± 0.73 µg/kg/min, lepirudin 0.14 ± 0.02 mg/kg/h. Laboratory monitoring tests utilized were the activated clotting time, activated partial thromboplastin time (aPTT), diluted thrombin time, and thromboelastography measures. The aPTT was utilized in most patients (95%). Thromboembolism, bleeding, or death were observed in 17%, 17%, and 23% of bivalirudin, argatroban, and lepirudin patients, respectively. Bivalirudin appears to be the most frequently used DTI in pediatric ECMO. Dosing and laboratory monitoring varied, and bleeding and thromboembolic events were reported in 17% of patients. Prospective studies are warranted to establish dosing, monitoring, safety, and efficacy of bivalirudin and other IV DTI in pediatric ECMO.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Systematic review of 28 studies (329 patients) of DTIs in pediatric ECMO. Bivalirudin used in 96.7% of patients, argatroban 2.7%, lepirudin 0.6%; thromboembolism, bleeding, death in 17%, 17%, 23% by drug.
Por qué esto importa para la hirudoterapia
Esta revisión sistemática de 28 estudios (14 informes de casos, 13 retrospectivos, 1 prospectivo; 329 pacientes menores de 18 años) caracterizó los inhibidores directos de trombina intravenosos utilizados para la anticoagulación en ECMO pediátrico, encontrando bivalirudina en el 96,7% de los pacientes, argatrobán en el 2,7% y lepirudina en el 0,6%; los eventos hemorrágicos y tromboembólicos se reportaron cada uno en el 17% de los pacientes. Para ASH, esta revisión tiene relevancia defendible porque la lepirudina es hirudina recombinante derivada de la sanguijuela medicinal (Hirudo medicinalis), lo que sitúa un producto del secretoma de la sanguijuela dentro del espectro de los IDT evaluados en esta población de alta gravedad, y la dosis de infusión de lepirudina reportada (0,14 ± 0,02 mg/kg/h) con datos de monitorización de laboratorio añade contexto traslacional para los clínicos interesados en la anticoagulación basada en hirudina. Una advertencia honesta es que la evidencia incluida es predominantemente observacional, y el resumen establece explícitamente que se justifican estudios prospectivos para establecer la dosificación, monitorización, seguridad y eficacia de estos agentes en ECMO pediátrico.
Citación
Anticoagulation with Intravenous Direct Thrombin Inhibitors in Pediatric Extracorporeal Membrane Oxygenation: A Systematic Review of the Literature.
Kiskaddon AL et al. · Seminars in thrombosis and hemostasis, 2023
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026