Outcomes of systemic anticoagulation with bivalirudin for Impella 5.0
Research article published in International journal of artificial organs (2021)
Abstract
Temporary mechanical circulatory support (tMCS) devices are used for the management of cardiogenic shock. The Impella 5.0 (Abiomed; Danvers, MA) (IMP5) is a commonly used, surgically implanted, tMCS device that requires systemic anticoagulation and purge solution to avoid pump failure. To avoid heparin-induced thrombocytopenia (HIT) from unfractionated heparin (UFH) use, our program has explored the utility of bivalirudin (BIV) for systemic anticoagulation in IMP5. This single center, retrospective study included patients supported on IMP5 with BIV based AC. The efficacy and safety end points were recovery, bridge to left ventricular assist device (LVAD), cardiac transplant (HTX), or death as well as clinically significant bleeding, incidence of Tissue Plasminogen Activator (tPA) use for suspected pump thrombosis, stroke, and device failure. There were 31 patients included, and 26 (84%) received BIV purge solutions. The median duration of IMP5 was 6 (IQR 4-10) days. Most patients were bridged to LVAD (39%, 12); 16% (5) were bridged to HTX, 16% (5) recovered, and 29% (9) died. One patient (3%) suffered from ischemic stroke and 12% (4) patients developed clinically significant bleeding. tPA was administered to 8 (26%) patients. Logistic regression analysis demonstrated that duration of IMP5 was a significant predictor of tPA use (OR 1.28; 95% Confidence Interval 1.04-1.56). There were no cases of pump failure. Our experience highlights the feasibility of utilizing BIV for routine AC use in IMP5.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Outcomes of systemic anticoagulation with bivalirudin for Impella 5.0.
Por qué esto importa para la hirudoterapia
Este estudio retrospectivo unicéntrico de 31 pacientes evaluó la bivalirudina —un inhibidor directo sintético de la trombina modelado a partir de la hirudina, el principal anticoagulante de la saliva de la sanguijuela medicinal— como anticoagulación sistémica para el dispositivo de soporte circulatorio Impella 5.0 implantado quirúrgicamente, reportando desenlaces que incluyen puente a LVAD (39%), puente a trasplante (16%), recuperación (16%), muerte (29%), ictus isquémico (3%), sangrado clínicamente significativo (12%) y uso de tPA por sospecha de trombosis de la bomba (26%), sin fallos de la bomba. Para ASH/hirudoterapia, este trabajo ilustra una aplicación clínica contemporánea de un principio terapéutico derivado del secretoma de la sanguijuela, demostrando cómo la anticoagulación basada en hirudina se extiende más allá de la terapia tradicional con sanguijuelas hacia escenarios avanzados de soporte circulatorio mecánico. Sin embargo, como una serie observacional pequeña y unicéntrica sin brazo de comparación, el estudio demuestra únicamente factibilidad y no puede establecer eficacia o seguridad comparativa frente a regímenes anticoagulantes basados en heparina o alternativos.
Citación
Outcomes of systemic anticoagulation with bivalirudin for Impella 5.0
Fabrizio C et al. · International journal of artificial organs, 2021
Contexto clínico relacionado
Explore cómo esta investigación se conecta con la práctica clínica
Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026