Bivalirudin for Alternative Anticoagulation in Extracorporeal Membrane Oxygenation: A Systematic Review
Systematic review published in Journal of intensive care medicine (2016)
Abstract
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) offers therapeutic options in refractory respiratory and/or cardiac failure. Systemic anticoagulation with heparin is routinely administered. However, in patients with heparin-induced thrombocytopenia or heparin resistance, the direct thrombin inhibitor bivalirudin is a valid option and has been increasingly used for ECMO anticoagulation. We aimed at evaluating its safety and its optimal dosing for ECMO. METHODS: Systematic web-based literature search of PubMed and EMBASE performed via National Health Service Library Evidence and manually, updated until January 30, 2016. RESULTS: The search revealed 8 publications relevant to the topic (5 case reports). In total, 58 patients (24 pediatrics) were reported (18 received heparin as control groups). Bivalirudin was used with or without loading dose, followed by infusion at different ranges (lowest 0.1-0.2 mg/kg/h without loading dose; highest 0.5 mg/kg/h after loading dose). The strategies for monitoring anticoagulation and optimal targets were dissimilar (activated partial thromboplastin time 45-60 seconds to 42-88 seconds; activated clotting time 180-200 seconds to 200-220 seconds; thromboelastography in 1 study). CONCLUSION: Bivalirudin loading dose was not always used; infusion range and anticoagulation targets were different. In this systematic review, we discuss the reasons for this variability. Larger studies are needed to establish the optimal approach with the use of bivalirudin for ECMO.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Bivalirudin for Alternative Anticoagulation in Extracorporeal Membrane Oxygenation: A Systematic Review.
Por qué esto importa para la hirudoterapia
Esta revisión sistemática evaluó la seguridad y la dosificación óptima de la bivalirudina —un inhibidor directo de la trombina según el resumen— como anticoagulante alternativo para la oxigenación por membrana extracorpórea en pacientes con trombocitopenia inducida por heparina o resistencia a la heparina. Analizando 8 publicaciones que englobaban 58 pacientes, los autores encontraron una variabilidad considerable en el uso de dosis de carga, los rangos de infusión y los objetivos de monitorización de la anticoagulación entre los centros. El resumen no menciona la hirudina, las sanguijuelas ni ninguna relación con la hirudoterapia, por lo que no puede establecerse una conexión defendible con ASH. La revisión está limitada por la base de evidencia subyacente, que estuvo compuesta predominantemente por casos clínicos, y los autores concluyen que se necesitan estudios más amplios para establecer el abordaje óptimo.
Citación
Bivalirudin for Alternative Anticoagulation in Extracorporeal Membrane Oxygenation: A Systematic Review
Sanfilippo F et al. · Journal of intensive care medicine, 2016
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026