Sociedad Americana de Hirudoterapia

Bivalirudin versus unfractionated heparin for prevention of hemofilter occlusion during continuous renal replacement therapy

Research article published in Pharmacotherapy (2010)

Última actualización: 18 de junio de 2026Revisado por: ASH Editorial Board
Artículo de investigación — revisión de evidenciaReferencia del artículo
Evidence: Randomized controlled trialDesarrollo de fármacosKiser TH et al. · Pharmacotherapy, 2010

Abstract

STUDY OBJECTIVE: To evaluate the safety and efficacy of bivalirudin compared with heparin for preventing hemofilter occlusion during continuous venovenous hemofiltration (CVVH). DESIGN: Prospective, randomized, double-blind study. SETTING: University-affiliated hospital. PATIENTS: Ten critically ill adults (median age 58 yrs, 70% male) with acute renal failure who, without anticoagulation, experienced hemofilter survival time of 24 hours or less during CVVH. INTERVENTION: Patients were randomized to receive bivalirudin 2 mg/hour (five patients) or heparin 400 units/hour (five patients) administered prefilter into the extracorporeal circuit. MEASUREMENTS AND MAIN RESULTS: Patients had a median Acute Physiology and Chronic Health Evaluation (APACHE) II score of 24, Sequential Organ Failure Assessment (SOFA) score of 11, and reduced antithrombin activity (75.5 units/dl). Baseline characteristics were not significantly different between groups. Study drug was administered in 40 hemofilters (18 from bivalirudin-treated patients, 22 from heparin-treated patients). The primary efficacy outcome was hemofilter survival time, defined as the interval of time between commencement of CVVH with a new extracorporeal circuit (hemofilter) and hemofilter failure. Compared with no anticoagulation, the addition of bivalirudin or heparin significantly improved hemofilter survival time (mean ± SD 10 ± 5 hrs with no anticoagulation vs 22 ± 18 hrs with anticoagulation, p=0.0005). Hemofilter survival time was significantly increased in patients receiving bivalirudin versus those receiving heparin (29.6 ± 20.7 vs 16.5 ± 13.6 hrs, p=0.045). Independent predictors of hemofilter survival were use of bivalirudin therapy and increased antithrombin III activity. No patients randomized to bivalirudin experienced any bleeding or thrombosis events; one patient who received heparin developed alveolar hemorrhage, and one developed a lower extremity deep vein thrombosis. CONCLUSION: Compared with heparin, bivalirudin was more efficacious in prolonging hemofilter survival time and was well tolerated. Additional studies of bivalirudin for prevention of hemofilter occlusion during continuous renal replacement therapy are warranted.

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

Publication typeComparative StudyJournal ArticleRandomized Controlled TrialResearch Support, Non-U.S. Gov't
Indexed MeSH termsAcute Kidney InjuryAnticoagulantsAntithrombinsCritical IllnessDouble-Blind MethodFemaleHemofiltrationHeparinHirudinsHumansMaleMiddle Aged

Resumen

Bivalirudin versus unfractionated heparin for prevention of hemofilter occlusion during continuous renal replacement therapy.

Por qué esto importa para la hirudoterapia

Este estudio prospectivo, aleatorizado y doble ciego en diez adultos críticos con insuficiencia renal aguda comparó bivalirudina (2 mg/h) frente a heparina (400 unidades/h) para la prevención de la oclusión del hemofiltro durante la hemofiltración venovenosa continua. La bivalirudina prolongó significativamente el tiempo de supervivencia del hemofiltro en comparación con la heparina (29,6 frente a 16,5 h), y ningún paciente tratado con bivalirudina experimentó sangrado ni trombosis, mientras que un paciente con heparina desarrolló hemorragia alveolar y otro desarrolló TVP. La relevancia para ASH radica en que la bivalirudina es un inhibidor directo de la trombina basado en la hirudina, lo que demuestra la eficacia de esta clase de fármacos inspirada en la sanguijuela en la anticoagulación de circuitos extracorpóreos. Sin embargo, el tamaño muestral fue muy pequeño (n=10), se trató de un agente farmacéutico en lugar de terapia con sanguijuelas o extracto crudo de sanguijuela, y los hallazgos requieren confirmación en estudios de mayor tamaño.

Citación

Bivalirudin versus unfractionated heparin for prevention of hemofilter occlusion during continuous renal replacement therapy

Kiser TH et al. · Pharmacotherapy, 2010

DOI

Contexto clínico relacionado

Explore cómo esta investigación se conecta con la práctica clínica

Drug PipelineDrug DevelopmentDirect Thrombin InhibitorsHirudinAnticoagulation CompoundsBivalirudinHemostasisUrologyOtolaryngology

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

Este sitio web proporciona información educativa y no constituye consejo médico, diagnóstico ni recomendaciones de tratamiento. La terapia con sanguijuelas medicinales conlleva riesgos clínicamente significativos y debe ser realizada únicamente por profesionales calificados bajo protocolos aprobados institucionalmente. La autorización 510(k) de la FDA para sanguijuelas medicinales se limita a indicaciones específicas; las discusiones sobre uso investigativo y fuera de indicación se señalan correspondientemente. Para orientación médica específica, consulte a un profesional de salud calificado.