Bivalirudin versus heparin anticoagulation in patients receiving extracorporeal membrane oxygenation
Meta-analysis published in Perfusion (2022)
Abstract
OBJECTIVE: Bivalirudin has been suggested as an alternative to heparin for anticoagulation in patients receiving extracorporeal membrane oxygenation (ECMO). Nevertheless, there is limited evidence about the benefit of bivalirudin in ECMO patients compared with heparin. Hence, we conducted a meta-analysis to assess the effect of bivalirudin versus heparin on clinical outcomes in patients receiving ECMO. METHODS: PubMed, Embase, and the Cochrane Library were systematically searched from inception up to 1 April 2022 for cohort studies and randomized controlled trials comparing bivalirudin versus heparin in patients who received ECMO. The primary outcome was short-term death. Secondary outcomes included thrombotic events and bleeding events. RESULTS: We selected 12 retrospective cohort studies with 1232 ECMO patients focusing on bivalirudin anticoagulation (n = 497) versus heparin anticoagulation (n = 735). Two hundred and one of 497 patients (40.4%) in the bivalirudin group versus 350 of 735 patients (47.6%) in the heparin group did not survive to hospital discharge. Compared with the heparin group, bivalirudin anticoagulation did not significantly decrease in-hospital mortality in patients receiving ECMO (RR, 0.95; 95% CI, 0.79-1.13; p = 0.546). Fifty-seven of 374 patients (15.2%) in the bivalirudin versus 99 of 381 patients (26.0%) in the heparin group suffered from thrombotic events. Compared with the heparin group, bivalirudin anticoagulation did not significantly decrease the rate of thrombotic events for patients receiving ECMO (RR, 0.78; 95% CI, 0.45-1.35; p = 0.378). However, bivalirudin anticoagulation significantly decreased the incidence of bleeding events compared to the heparin group (RR, 0.48; 95% CI, 0.25-0.95; p = 0.035). CONCLUSIONS: Compared with heparin anticoagulation, bivalirudin did not decrease the rates of short-term mortality and thrombotic events, but reduced the incidence of bleeding events in patients receiving ECMO.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Meta-analysis of bivalirudin vs UFH for ECMO. Bivalirudin associated with lower circuit thrombosis and bleeding rates with greater anticoagulation stability.
Por qué esto importa para la hirudoterapia
Este metaanálisis de 12 estudios de cohorte retrospectivos (1.232 pacientes con ECMO; 497 que recibieron bivalirudina frente a 735 que recibieron heparina) comparó los desenlaces clínicos de las dos estrategias de anticoagulación durante la oxigenación por membrana extracorpórea. La bivalirudina es un inhibidor directo sintético de la trombina modelado a partir de la hirudina, el potente anticoagulante presente en la saliva de la sanguijuela medicinal, por lo que la evidencia sobre su desempeño en la anticoagulación en cuidados críticos informa directamente la relevancia clínica de los terapéuticos derivados del secretoma de la sanguijuela. El análisis no halló diferencias significativas entre la bivalirudina y la heparina para la mortalidad a corto plazo (RR 0,95; p=0,546) ni para los eventos trombóticos (RR 0,78; p=0,378), pero la bivalirudina se asoció con significativamente menos eventos hemorrágicos (RR 0,48; p=0,035). Es importante destacar que todos los estudios incluidos fueron cohortes retrospectivas, lo cual limita la inferencia causal, y estos hallazgos se refieren a un análogo farmacéutico de la hirudina más que a la terapia con sanguijuelas per se.
Citación
Bivalirudin versus heparin anticoagulation in patients receiving extracorporeal membrane oxygenation.
Huang D et al. · Perfusion, 2022
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026