Heparin Versus Bivalirudin in Pediatric Patients Assisted With Mechanical Circulatory Support: A Retrospective Before-and-after Study
Retrospective cohort published in J Cardiothorac Vasc Anesth (2025)
Abstract
OBJECTIVES: Children assisted with mechanical circulatory support experience bleeding and thrombotic complications that may depend upon anticoagulation strategies. The primary aim of this study was to compare the incidence of thrombotic events in pediatric heart failure patients assisted with mechanical circulatory support with the use of bivalirudin versus heparin anticoagulation. A secondary aim was to compare the percentage of out-of-range partial thromboplastin time values between these anticoagulants. DESIGN: Retrospective cohort study. SETTING: Tertiary pediatric cardiac intensive care unit. PARTICIPANTS: Pediatric patients undergoing mechanical circulatory support for cardiac failure. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 36 pediatric patients on mechanical support treated with either heparin (n.18) or bivalirudin (n.18) during the first 30 days of intensive care unit admission were compared. Bivalirudin group data were retrieved from February 2018 to August 2020 while data on the heparin group were extrapolated from 2015 to 2017. A comparison of anticoagulation was conducted specifically in EXCOR Berlin Heart and extracorporeal membrane oxygenation patients. Berlin Heart patients showed 1 (12.5%) versus 8 (80%) thrombotic episodes in the bivalirudin and heparin groups, respectively (p = 0.005), 0 and 3 (30%) cerebrovascular events, and 0 versus 3 (30%) death episodes, respectively (p = 0.054). In extracorporeal membrane oxygenation patients, the bivalirudin and heparin groups showed 0 versus 1 (8.3%) patient with a thrombosis episode (p = 0.40), 0 and 0 cerebrovascular events, and 5 (50%) versus 3 (25%) death episodes, respectively (p = 0.169). The number of out-of-range partial thromboplastin time values was higher in the heparin group both in Berlin Heart and extracorporeal membrane oxygenation patients (p < 0.0001). CONCLUSIONS: In a cohort of children with heart failure, bivalirudin use was associated with a reduction in thrombotic events in Berlin Heart patients compared with heparin over a period of 30 days.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Retrospective comparison of 36 pediatric MCS patients showed Berlin Heart bivalirudin (12.5%) versus heparin (80%) thrombotic episodes (p=0.005) and fewer cerebrovascular events.
Por qué esto importa para la hirudoterapia
This retrospective cohort study compared the incidence of thrombotic events and out-of-range partial thromboplastin time values between bivalirudin and heparin anticoagulation in 36 pediatric patients on mechanical circulatory support—including Berlin Heart EXCOR and ECMO patients—during the first 30 days of intensive care unit admission. The authors report significantly fewer thrombotic episodes in Berlin Heart patients treated with bivalirudin versus heparin (12.5% vs 80%, p = 0.005), fewer cerebrovascular events and deaths, and significantly fewer out-of-range PTT values across both device groups (p < 0.0001). The abstract does not mention hirudin, leeches, or any leech-derived compound, so no defensible hirudotherapy link exists. This is a retrospective study with a before-and-after design rather than randomization, involves small per-group sample sizes, and does not involve leeches or hirudotherapy.
Citación
Heparin Versus Bivalirudin in Pediatric Patients Assisted With Mechanical Circulatory Support: A Retrospective Before-and-after Study.
Giorni C et al. · Journal of cardiothoracic and vascular anesthesia, 2025
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: June 18, 2026