Comparison of bleeding and thrombotic outcomes in veno-venous extracorporeal membrane oxygenation: Heparin versus bivalirudin
Research article published in European journal of haematology (2024)
Abstract
OBJECTIVES: We aimed to evaluate thrombotic and hemorrhagic complications with heparin versus bivalirudin use in veno-venous extracorporeal membrane oxygenation (V-V ECMO). METHODS: We performed a retrospective cohort study of adult patients placed on V-V ECMO with intravenous anticoagulation with either heparin or bivalirudin. Time to thrombotic event and major bleed were analyzed in addition to related outcomes. RESULTS: We identified 95 patients placed on V-V ECMO: 61 receiving heparin, 34 bivalirudin. The bivalirudin group had a higher rate of severe COVID-19, higher BMI, and longer ECMO duration. Despite this, bivalirudin was associated with reduced risk of thrombotic event (HR 0.14, 95% CI 0.06-0.32, p < .001) and increased average lifespan of the circuit membrane lung (16 vs. 10 days, p = 0.004). While there was no difference in major bleeding, the bivalirudin group required fewer transfusions of packed red blood cells and platelets per 100 ECMO days (means of 13 vs. 39, p = 0.004; 5 vs. 19, p = .014, respectively). Lastly, the bivalirudin group had improved survival to ECMO decannulation in univariate analysis (median OS 53 vs. 26 days, p = .015). CONCLUSIONS: In this real-world analysis of bivalirudin versus heparin, bivalirudin is a viable option for V-V ECMO and associated with lower risk of thrombotic complications and fewer transfusion requirements.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Peer-reviewed pharmacology and drug-development research relevant to anticoagulants and leech-derived compounds. Indexed in PubMed and verified against the NCBI record.
Por qué esto importa para la hirudoterapia
Este estudio de cohorte retrospectivo de 95 adultos en ECMO veno-venoso comparó la anticoagulación con heparin (n=61) frente a bivalirudin (n=34) y encontró que bivalirudin se asoció con un riesgo marcadamente menor de eventos trombóticos (HR 0.14, IC 95% 0.06-0.32), una mayor vida útil del circuito membrana-pulmón y menos transfusiones, sin diferencias en sangrados mayores. La conexión con la hirudoterapia reside en bivalirudin, un inhibidor directo de la trombina sintético cuyo linaje de diseño se remonta a hirudin, el péptido anticoagulante del secretoma de la sanguijuela medicinal; estudios como este ilustran cómo la farmacología de inhibición de la trombina derivada de sanguijuelas ha evolucionado hacia anticoagulantes parenterales convencionales que compiten clínicamente con heparin. Como advertencia honesta, se trata de una cohorte retrospectiva de un solo centro con grupos de tamaño modesto y desequilibrados (el brazo de bivalirudin difería en la gravedad de COVID-19, el IMC y la duración de la ECMO), por lo que respalda a bivalirudin como una opción viable en lugar de demostrar superioridad, y se refiere a un fármaco manufacturado, no a la terapia con sanguijuelas ni al secretoma completo de la sanguijuela.
Citación
Comparison of bleeding and thrombotic outcomes in veno-venous extracorporeal membrane oxygenation: Heparin versus bivalirudin.
Kartika et al. · European journal of haematology, 2024
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 29, 2026 · Última actualización del sitio: June 18, 2026