Heparin vs bivalirudin anticoagulation for extracorporeal membrane oxygenation.
Research article published in Journal of cardiac surgery (2020)
Abstract
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) induces hemostatic alterations that may contribute to hematological complications. Unfractionated heparin (UFH) is the mainstay antithrombotic in ECMO and depends on antithrombin III (AT III) to exhibit its actions. However, it bears the risk for heparin-induced thrombocytopenia. Bivalirudin is a direct thrombin inhibitor and is inherently not dependent on AT III. AIM OF THE STUDY: To assess the efficacy and safety profiles of UFH compared with bivalirudin during ECMO support. METHODS: We retrospectively reviewed 52 adult patients who were supported by ECMO from 1 January 2013 to 1 September 2018. Among them, 33 received UFH and 19 received bivalirudin. We analyzed their 7-day rate of composite thrombotic, bleeding, and mortality episodes while on anticoagulation. RESULTS: There were no statistical differences in the 7-day rate of composite thrombosis (33.3% vs 26.3%; P = 0.60), major bleeding (18.2% vs 5.3%; P = .24), 30-day mortality, (42.4% vs 26.3%; P = .37), or in-hospital mortality (45.5% vs 36.8%; P = .58). The percentage of time activated partial thromboplastin time (aPTT) was within the therapeutic range was higher with bivalirudin (50% vs 85.7%; P = .007). CONCLUSIONS: This study suggests that UFH and bivalirudin are associated with similar rates of thrombosis, major bleeding, and mortality events in patients supported by ECMO. However, it was observed that bivalirudin consistently maintained aPTT within the therapeutic range in comparison to UFH.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Extracorporeal membrane oxygenation (ECMO) induces hemostatic alterations that may contribute to hematological complications. Unfractionated heparin (UFH) is the mainstay antithrombotic in ECMO and depends on antithrombin III (AT III) to exhibit its actions.
Por qué esto importa para la hirudoterapia
Kaseer et al. (2020, J. Card. Surg.) revisaron retrospectivamente 52 pacientes adultos en ECMO (33 en heparina no fraccionada, 19 en bivalirudina) y no encontraron diferencias estadísticamente significativas en trombosis compuesta de 7 días, sangrado mayor o mortalidad, mientras que la bivalirudina mantuvo la aPTT dentro del rango terapéutico de manera más consistente (50% frente a 85.7% del tiempo, P = .007). La conexión de la hirudoterapia es conceptual y mecanicista: la bivalirudina es un inhibidor directo de la trombina que, a diferencia de la heparina, no depende de la antitrombina III — el mismo principio de inhibición directa de la trombina que encarna el péptido derivado de la lombriz medicinal hirudina (el conjunto de palabras clave de PubMed para este registro incluso incluye "Hirudins"), ilustrando cómo el secretoma de la lombriz medicinal inspiró una clase reconocida de anticoagulantes. Advertencias honestas: esto es una comparación retrospectiva de pequeño tamaño y de un solo centro (no es un ensayo aleatorio), estudia el agente sintético bivalirudina en lugar de la terapia de lombriz o la hirudina nativa, y no saca conclusiones sobre la hirudoterapia.
Citación
Heparin vs bivalirudin anticoagulation for extracorporeal membrane oxygenation.
Kaseer et al. · Journal of cardiac surgery, 2020
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: June 18, 2026