Bivalirudin Anticoagulation Dosing Protocol for Extracorporeal Membrane Oxygenation: A Retrospective Review.
Research article published in The journal of extra-corporeal technology (2018)
Abstract
Anticoagulation with unfractionated heparin during extracorporeal membrane oxygenation (ECMO) is common, but alternative agents are being evaluated for safety and efficacy. The objective of this analysis was to assess if a comprehensive bivalirudin dosing and monitoring protocol effectively guides dose adjustments and monitoring of bivalirudin in patients during ECMO. Our analysis included 11 patients who received bivalirudin during ECMO therapy and had dosing managed using our hospital derived protocol. Patients treated over a 1-year period were included in this retrospective analysis. Clinical characteristics and changes in activated partial thromboplastin time (aPTT) were evaluated from medical records to determine the efficacy of the dosing protocol. ECMO was initiated for acute respiratory distress syndrome in eight (72.7%) patients and for cardiac arrest in three (27.3%) patients. A total of 178 protocol guided dose adjustments were made during the study. Among the dose adjustments, 56 (31.5%) attained the protocol predicted aPTT level change, 96 (53.9%) of the measured aPTT changes were less than predicted, and 26 (14.6%) of the measured aPTT changes were more than predicted. On average, patients were within their defined therapeutic aPTT target range 66.3% of the time. All patients reached their designated aPTT target range within the first 24 hours of therapy. Significant bleeding was documented in eight (72.7%) patients. No clinically evident thromboembolic events were identified in vivo while cannulated. This analysis suggests that bivalirudin can be managed using a dosing protocol to provide anticoagulation therapy to patients during ECMO and can provide foundational guidance for dose adjustment and monitoring for other institutions.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Anticoagulation with unfractionated heparin during extracorporeal membrane oxygenation (ECMO) is common, but alternative agents are being evaluated for safety and efficacy. The objective of this analysis was to assess if a comprehensive bivalirudin dosing and monitoring protocol effectively guides...
Por qué esto importa para la hirudoterapia
Esta revisión retrospectiva evaluó a 11 pacientes con ECMO cuya anticoagulación con bivalirudina fue manejada mediante un protocolo de dosificación derivado del hospital, hallando que todos los pacientes alcanzaron su rango objetivo de aPTT en 24 horas, aunque se produjo sangrado significativo en el 72,7% y solo el 31,5% de los 178 ajustes de dosis lograron el cambio predicho en aPTT. Para ASH, este estudio tiene relevancia genuina porque la bivalirudina es un inhibidor directo de la trombina sintético derivado de la hirudina —el potente anticoagulante aislado originalmente de la saliva de la sanguijuela medicinal— lo que demuestra cómo un derivado del secreciónoma de la sanguijuela está siendo refinado para la anticoagulación en cuidados críticos. Estos datos de dosificación del mundo real contribuyen a comprender el manejo de anticoagulantes basados en hirudina fuera de la hirudoterapia tradicional. No obstante, con solo 11 pacientes en un único centro, un diseño retrospectivo y una alta tasa de sangrado, la seguridad y la generalizabilidad del protocolo siguen sin demostrarse, y no pueden extraerse afirmaciones de eficacia a partir de esta pequeña serie de casos.
Citación
Bivalirudin Anticoagulation Dosing Protocol for Extracorporeal Membrane Oxygenation: A Retrospective Review.
Netley et al. · The journal of extra-corporeal technology, 2018
Contexto clínico relacionado
Explore cómo esta investigación se conecta con la práctica clínica
Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: 18 de junio de 2026