Nitric oxide in the ECMO circuit as a treatment option for heparin-induced thrombocytopenia: A case report

Case report published in Perfusion (2026)

Última actualización: June 18, 2026Revisado por: ASH Editorial Board

Research article — evidence reviewArticle reference

Evidence: Research reportDesarrollo de fármacosEnsayos clínicosJoelsons D et al. · Perfusion, 2026

Abstract

IntroductionExtracorporeal membrane oxygenation (ECMO) involves the use of a synthetic circuit, which initiates a complex interplay of inflammatory and pro-coagulant responses. This intricate, self-reinforcing process results in a prothrombotic state, predisposing patients to arterial, venous, or oxygenator thrombosis. Unfractionated heparin is the standard anticoagulant chosen in ECMO patients to prevent such complications.Case ReportIn this case report our patient presented heparin-induced thrombocytopenia (HIT), a possible complication.DiscussionAlternative strategies such as bivalirudin and argatroban are possible options but due the unavailability of those medications at our institution, nitric oxide (NO) via sweep-gas flow was deemed a reasonable alternative considering it's anti-aggregant effect.ConclusionThis case report details the use of NO as a possible alternative anticoagulant strategy in a patient with ECMO complicated by HIT.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Publication typeJournal Article

Resumen

Reports use of sweep-gas nitric oxide as an unconventional anti-aggregant alternative on the ECMO circuit when bivalirudin and argatroban were unavailable to manage HIT during ECMO.

Por qué esto importa para la hirudoterapia

This case report describes the use of nitric oxide (NO) via sweep-gas flow as an alternative anticoagulant strategy in an ECMO patient who developed heparin-induced thrombocytopenia (HIT), when bivalirudin and argatroban were unavailable at the institution. The abstract notes NO's anti-aggregant effect as the rationale for its use and details no other management options employed. The article has no relevance to ASH's domain: the abstract does not mention hirudin, lepirudin, leeches, or any leech-derived therapy, and the focus is entirely on NO as a novel ECMO anticoagulation workaround. CAVEAT: This is a single case report with no leech-related content and no direct connection to hirudotherapy or the leech secretome.

Citación

Nitric oxide in the ECMO circuit as a treatment option for heparin-induced thrombocytopenia: A case report.

Joelsons D et al. · Perfusion, 2026

DOI

Contexto clínico relacionado

Explore cómo esta investigación se conecta con la práctica clínica

Drug Pipeline Drug Development Direct Thrombin Inhibitors Clinical Evidence Clinical Applications Hirudin Anticoagulation Compounds Bivalirudin Hemostasis Otolaryngology

Aviso legal — investigación y educación

La información en esta página se proporciona únicamente con fines educativos e informativos y no constituye asesoramiento médico, diagnóstico o recomendaciones de tratamiento. Los resúmenes de evidencia clínica reflejan la literatura publicada revisada por pares y no implican eficacia terapéutica fuera de los contextos autorizados por la FDA.

La autorización FDA 510(k) para sanguijuelas medicinales se limita a indicaciones específicas. Las aplicaciones en investigación y fuera de indicación se identifican como tales. Los profesionales deben consultar las directrices vigentes de la FDA, los protocolos institucionales y las normativas estatales aplicables antes del uso clínico.

ASH apoya la evaluación rigurosa basada en evidencia de todas las aplicaciones de hirudoterapia mediante ensayos clínicos controlados e investigación revisada por pares.

Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: June 18, 2026