Bivalirudin in Extracorporeal Membrane Oxygenation
Research article published in Journal of cardiovascular pharmacology (2024)
Abstract
Extracorporeal membrane oxygenation (ECMO) is a mechanical support treatment modality used in patients with refractory cardiac and/or pulmonary failure. Bleeding and thrombotic complications associated with ECMO are inherent concerns that require careful management. Anticoagulation optimization may help mitigate these risks by providing more adequate therapeutic anticoagulation and lessen the bleed risk. Heparin, the most used anticoagulant, carries concerns for heparin-induced thrombocytopenia and possible resistance given its dependence on cofactors and circulating proteins to exert its pharmacologic effect. In contrast, bivalirudin, a direct thrombin inhibitor, exerts its effect independent of cofactors or plasma proteins, and possesses thrombin-binding and metabolism features that may confer advantages in ECMO management. This review of the evidence for bivalirudin utilization in ECMO suggests favorable outcomes in circuit-related thrombosis, bleeding, and dosing reliability. In addition, blood product utilization, circuit interventions, and success in ECMO decannulation and survival were positive findings associated with bivalirudin that merit consideration. Common questions and concerns relative to bivalirudin utilization, including laboratory monitoring, utilization in low-flow states, dosing considerations in renal replacement therapy, reversibility, and cost are also discussed in this review. Moreover, this review suggests that bivalirudin utilization presents the opportunity for ECMO management simplification.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Bivalirudin in Extracorporeal Membrane Oxygenation.
Por qué esto importa para la hirudoterapia
Esta revisión examina la evidencia sobre el uso de bivalirudina —un inhibidor directo de la trombina que actúa con independencia de cofactores o proteínas plasmáticas— como alternativa a la heparina para la anticoagulación durante la oxigenación por membrana extracorpórea (ECMO), analizando la trombosis del circuito, el sangrado, la dosificación, la monitorización, las consideraciones sobre terapia de reemplazo renal y el coste. Los autores sugieren resultados favorables y una posible simplificación del manejo de la anticoagulación en ECMO. Para ASH, no existe ninguna conexión defendible con la sanguijuela o la hirudoterapia a partir del resumen: este no menciona sanguijuelas, hirudina ni terapia derivada de la sanguijuela. Advertencia honesta: se trata de una revisión sin datos originales, que no involucra directamente sanguijuelas ni terapia con sanguijuelas, y el contexto de la ECMO está muy alejado de la práctica de la hirudoterapia.
Citación
Bivalirudin in Extracorporeal Membrane Oxygenation
Dunham S et al. · Journal of cardiovascular pharmacology, 2024
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026