Retrospective, Single-Center Cohort Study of Bivalirudin Compared to Unfractionated Heparin in Patients Receiving Extracorporeal Membrane Oxygenation
Clinical research published in Ann Pharmacother (2025)
Abstract
BACKGROUND: Extracorporeal membrane oxygenation (ECMO), a form of temporary mechanical circulatory support, causes a prothrombotic state due to activation of inflammatory processes via exposure of blood to the circuit. Systemic anticoagulation is recommended to prevent thrombosis. Unfractionated heparin (UFH) and direct thrombin inhibitors (DTIs) are anticoagulant agents that inactivate thrombin; however, UFH requires antithrombin III (ATIII) for its activity, and patients supported by ECMO are at risk for acquired ATIII deficiency. In addition, heparin may cause heparin-induced thrombocytopenia, complicating therapy. Guidelines on anticoagulant use in ECMO reference UFH as a recommended agent with DTIs as an alternative option. Meta-analyses comparing the 2 agents in ECMO have evaluated efficacy and safety; however, discordant results prompt the need for additional research. OBJECTIVE: The objective of this study is to evaluate differences in bleeding and thrombotic events between UFH and bivalirudin for anticoagulation during ECMO support. METHODS: This study is a retrospective, single-center cohort study conducted at a primary ECMO center and a tertiary academic medical center. RESULTS: Bleeding and systemic thrombosis rates were not different between bivalirudin and UFH (30 vs 33 events, hazard ratio [HR] = 0.89; 95% confidence interval [CI] = 0.55-1.47, P = 0.7; 12 vs 17 events, HR = 0.68; 95% CI = 0.32-1.42, P = 0.3); however, when controlled for covariates, device thrombosis was lower with bivalirudin (30.2% vs 43.4%, P = 0.017). Time in therapeutic range (TTR) was higher with bivalirudin (69.98% vs 55.5%, P < 0.001). CONCLUSION AND RELEVANCE: When compared to heparin, bivalirudin for anticoagulation in ECMO was associated with a decreased rate of device thrombosis and greater TTR.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Single-center retrospective cohort comparing bivalirudin to unfractionated heparin for anticoagulation during extracorporeal membrane oxygenation (ECMO). Documents bleeding, thrombotic events, and circuit complications.
Por qué esto importa para la hirudoterapia
Este estudio retrospectivo de cohorte, unicéntrico, comparó la bivalirudina con la heparina no fraccionada para la anticoagulación sistémica durante la oxigenación por membrana extracorpórea (ECMO), informando que la bivalirudina se asoció con menores tasas de trombosis del dispositivo (30,2% frente a 43,4%; P=0,017) y un mayor tiempo dentro del rango terapéutico (69,98% frente a 55,5%; P<0,001), sin diferencias significativas en el sangrado global ni en la trombosis sistémica. El resumen identifica la bivalirudina como un inhibidor directo de la trombina, pero no menciona la hirudina, las sanguijuelas ni la terapia con sanguijuelas. No puede establecerse una conexión defendible con la hirudoterapia o el secretoma de la sanguijuela a partir únicamente de este resumen, ya que no contiene ninguna referencia a compuesto alguno derivado de la sanguijuela. Por lo tanto, el estudio no es directamente relevante para el ámbito de la ASH.
Citación
Retrospective, Single-Center Cohort Study of Bivalirudin Compared to Unfractionated Heparin in Patients Receiving Extracorporeal Membrane Oxygenation.
Lofy T et al. · The Annals of pharmacotherapy, 2025
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026