Dosing Reliability of Direct Thrombin Inhibitors in Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis
Meta-analysis published in ASAIO journal (American Society for Artificial Internal Organs : 1992) (2025)
Abstract
Empirical evidence suggests direct thrombin inhibitors (DTIs) produce more favorable hemostatic outcomes than heparin in patients supported by extracorporeal membrane oxygenation (ECMO), yet the exact mechanisms responsible are unknown. We systematically searched databases and registers for studies comparing DTIs to heparin in humans receiving ECMO. A total of 28 studies were identified, most of which (n = 25) used bivalirudin, while the rest (n = 3) used argatroban. In random-effects meta-analysis, DTIs achieved the therapeutic anticoagulation range faster (mean difference = -6.96 hours, 95% confidence interval [CI] = -11.98 to -1.95, p = 0.006) and maintained the therapeutic range for a greater proportion of time (mean difference = 18.6%, 95% CI = 8.78-28.42, p < 0.001) than heparin. Subgroup analysis revealed these effects were similarly significant in adult patients and when bivalirudin was the DTI; however, they were not significant in pediatric patients or when argatroban was the DTI. Sensitivity analysis confirmed robustness of the primary findings in only low-risk of bias studies and in only studies published as full papers. In summary, DTIs-specifically bivalirudin-were associated with faster time to therapeutic anticoagulation and maintained the goal range for a greater percentage of time than heparin during ECMO support.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Empirical evidence suggests direct thrombin inhibitors (DTIs) produce more favorable hemostatic outcomes than heparin in patients supported by extracorporeal membrane oxygenation (ECMO), yet the exact mechanisms responsible are unknown.
Por qué esto importa para la hirudoterapia
Esta revisión sistemática y metanálisis identificó 28 estudios que comparaban inhibidores directos de la trombina (IDT) con heparina para la anticoagulación durante la oxigenación por membrana extracorpórea (ECMO), encontrando que los IDT —predominantemente bivalirudina (25 estudios), con argatrobán en 3— lograron una anticoagulación terapéutica más rápida y la mantuvieron durante una mayor proporción de tiempo que la heparina. Los análisis de subgrupos mostraron significancia en adultos y con bivalirudina, pero no en pacientes pediátricos ni con argatrobán. El resumen no menciona hirudina, sanguijuelas ni ningún agente derivado de sanguijuela, por lo que no puede establecerse una conexión defendible con la hirudoterapia o el secretoma de la sanguijuela a partir del propio artículo; cualquier vínculo de este tipo constituiría conocimiento externo. Por lo tanto, la relevancia para ASH no queda establecida a partir de este resumen.
Citación
Dosing Reliability of Direct Thrombin Inhibitors in Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis
Wieruszewski PM et al. · ASAIO journal (American Society for Artificial Internal Organs : 1992), 2025
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026