Utilization and outcomes of children treated with direct thrombin inhibitors on paracorporeal ventricular assist device support
Multicenter cohort published in ASAIO Journal (2020)
Abstract
Thrombotic and bleeding complications have historically been major causes of morbidity and mortality in pediatric ventricular assist device (VAD) support. Standard anticoagulation with unfractionated heparin is fraught with problems related to its heterogeneous biochemical composition and unpredictable pharmacokinetics. We sought to describe the utilization and outcomes in children with paracorporeal VAD support who are treated with direct thrombin inhibitors (DTIs) antithrombosis therapy. Retrospective multicenter review of all pediatric patients (aged <19 years) treated with a DTI (bivalirudin or argatroban) on paracorporeal VAD support, examining bleeding and thrombotic adverse events. From May 2012 to 2018, 43 children (21 females) at 10 centers in North America, median age 9.5 months (0.1-215 months) weighing 8.6 kg (2.8-150 kg), were implanted with paracorporeal VADs and treated with a DTI. Diagnoses included cardiomyopathy 40% (n = 17), congenital heart disease 37% (n = 16; single ventricle n = 5), graft vasculopathy 9% (n = 4), and other 14% (n = 6). First device implanted included Berlin Heart EXCOR 49% (n = 21), paracorporeal continuous flow device 44% (n = 19), and combination of devices in 7% (n = 3). Adverse events on DTI therapy included; major bleeding in 16% (n = 7) (2.6 events per 1,000 patient days of support on DTI), and stroke 12% (n = 5) (1.7 events per 1,000 patient days of support on DTI). Overall survival to transplantation (n = 30) or explantation (n = 8) was 88%. This is the largest multicenter experience of DTI use for anticoagulation therapy in pediatric VAD support. Outcomes are encouraging with lower major bleeding and stroke event rate than that reported in literature using other anticoagulation agents in pediatric VAD support.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
ACTION network cohort of children on paracorporeal VADs receiving direct thrombin inhibitors (bivalirudin/argatroban). DTI use safe and effective for HIT-positive and heparin-failure patients.
Por qué esto importa para la hirudoterapia
This retrospective multicenter review examined 43 children (median age 9.5 months) on paracorporeal ventricular assist device (VAD) support treated with direct thrombin inhibitors—bivalirudin or argatroban—at 10 North American centers from 2012–2018. Major bleeding occurred in 16% (2.6 events per 1,000 patient-days), stroke in 12% (1.7 events per 1,000 patient-days), and overall survival to transplant or explantation was 88%, with the authors noting lower bleeding and stroke event rates than reported in the literature for other anticoagulants in pediatric VAD support. This represents the largest multicenter experience of DTI use in pediatric VAD support. For ASH's domain, this study has no defensible connection to hirudotherapy or the leech secretome—the abstract discusses pharmaceutical DTIs without any mention of leeches, hirudin, or leech-derived compounds.
Citación
Utilization and outcomes of children treated with direct thrombin inhibitors on paracorporeal ventricular assist device support.
VanderPluym CJ et al. · ASAIO journal, 2020
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: June 18, 2026