Current use and limitations of direct thrombin inhibitors in pediatric ECMO: A European survey
Research article published in Perfusion (2026)
Abstract
IntroductionDirect thrombin inhibitors (DTIs) are an alternative to unfractionated heparin during pediatric ECMO. We aimed to describe their use and limitations across Europe.MethodsFifty-two pediatric EuroELSO centers were surveyed from July to December 2025. Thirty-seven respondents were analyzed across 11 countries.ResultsMost centers (n = 30, 81.1%) were referral sites for pediatric cardiothoracic surgery and 20 (54.1%) also provided non-ECMO mechanical support (i.e., ventricular assist devices [VADs]). Seventeen (45.9%) centers reported having used DTIs for the maintenance of systemic anticoagulation during ECMO at least once over the last years. Of these 17 centers, only 3 (17.6%) use DTIs as a first-line anticoagulant for pediatric ECMO. Most centers (n = 11/17, 64.7%) reserve DTIs for specific situations, such as VAD patients or suspected heparin-induced thrombocytopenia. Among the 17 respondents who reported using DTIs, bivalirudin (BIV) was identified as the preferred agent by 16 (94.1%). Dedicated protocols for DTIs management are implemented in 12 (70.6%) out of these 17 centers. Activated partial prothrombin time is the primary assay for monitoring BIV anticoagulation. From the 16 centers using BIV, only 4 (25.0%) reported having specific assays available. The main reported barrier for DTIs implementation was the lack of guidelines and published protocols (n = 14/20, 70.0%).ConclusionAlthough recent studies have discussed the interest in DTIs, their adoption as first-line anticoagulant during pediatric ECMO remains limited. Findings from this survey indicate the need for more evidence of DTIs clinical benefit, as well as robust guidelines regarding their protocolized use during pediatric ECMO.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Current use and limitations of direct thrombin inhibitors in pediatric ECMO: A European survey.
Por qué esto importa para la hirudoterapia
Esta encuesta europea realizada a 37 centros pediátricos de ECMO en 11 países examinó el uso actual y las limitaciones de los inhibidores directos de la trombina (IDT) como alternativas a la heparina no fraccionada, hallando que, entre los 17 centros que notificaron uso de IDT, la bivalirudina fue el agente preferido en el 94,1 % (16/17), aunque solo 3 centros empleaban los IDT como anticoagulantes de primera línea y la principal barrera para una adopción más amplia fue la falta de guías y protocolos publicados. Para ASH y la hirudoterapia, este estudio es directamente relevante porque la bivalirudina es un análogo sintético de la hirudina derivado del anticoagulante de la sanguijuela medicinal, lo que ilustra cómo un terapéutico inspirado en el secretoma de la sanguijuela se está adoptando de forma selectiva en cuidados cardiopulmonares críticos. No obstante, al tratarse de una encuesta sobre patrones de práctica autoinformados y no de un ensayo clínico, capta tendencias de uso y barreras percibidas —no eficacia comparativa ni resultados de seguridad— y los propios autores señalan la necesidad de más evidencia sobre el beneficio clínico de los IDT.
Citación
Current use and limitations of direct thrombin inhibitors in pediatric ECMO: A European survey
Gardeton T et al. · Perfusion, 2026
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026