Catheter-Directed Bivalirudin for Local Anticoagulation and Clot Dissolution in Children Requiring Mechanical Circulatory Support
Chaudhry-Waterman N, Schardt TQ, Soderstrom RM, Warren BB, Buckvold S, Morgan G, Kim JS (2025) · ASAIO Journal · n=3
Характеристика исследования
- Дизайн
- case series of three pediatric mechanical circulatory support patients receiving catheter-directed bivalirudin for localized thrombolysis (Children's Hospital Colorado)
- Размер выборки (n)
- 3
- Вмешательство
- Direct bivalirudin delivery via catheter to localized intracardiac/circuit thrombosis in MCS patients
- Компаратор
- Historical alteplase-based catheter-directed thrombolysis
- Первичная конечная точка
- Thrombus resolution and bleeding complications after catheter-directed bivalirudin
- Основной результат
- Direct bivalirudin delivery associated with rapid thrombus resolution in all three cases; novel application combining anticoagulant prevention with active fibrin-bound thrombin clearance
- Длительность наблюдения
- Acute MCS course
- PMID
- 40960390
Ключевые выводы
- First reported pediatric catheter-directed bivalirudin thrombolysis series
- All three cases achieved rapid thrombus resolution
- Used in patients with alteplase contraindications (bleeding history)
- Leverages bivalirudin's fibrin-bound thrombin inhibition
- Novel application warranting larger series
Ограничения
- Only 3 cases - hypothesis-generating only
- Single-center experience
- No control comparison
- Dosing not standardized for catheter-directed application
- Not applicable to whole-leech hirudotherapy
Клиническое значение
Chaudhry-Waterman 2025 introduces novel catheter-directed bivalirudin use for localized thrombolysis in pediatric MCS patients. For ASH, this case series demonstrates the ongoing innovation cycle in the synthetic hirudin-derivative pharmaceutical pathway - new applications discovered through reasoning about mechanism (fibrin-bound thrombin inhibition). The K040187 device-leech US clinical practice operates under a more stable indication landscape without analogous novel-use innovation.
Связанные исследования
Prospective Randomized Pilot Study Comparing Bivalirudin Versus Heparin in Neonatal and Pediatric Extracorporeal Membrane Oxygenation
McMichael A, Weller J, Li X, Hatton L, Zia A, Raman L (2024)
Efficacy of Bivalirudin for Therapeutic Anticoagulation in COVID-19 Patients Requiring ECMO Support
Trigonis R, Smith N, Porter S, Anderson E, Jennings M, Kapoor R, Hage C, Moiz S, Garcia J, Rahman O (2021)
Bivalirudin versus heparin anticoagulation in patients receiving extracorporeal membrane oxygenation
Huang D, Guan Q, Qin J, Shan R, Wu J, Zhang C (2022)
Heparin-based versus bivalirudin-based anticoagulation in pediatric extracorporeal membrane oxygenation: A systematic review
Valdes CA, Sharaf OM, Bleiweis MS, Jacobs JP, Mumtaz M, Sharaf RM, Jeng EI, Peek GJ (2023)