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) · Journal of Cardiothoracic and Vascular Anesthesia · n=42
Характеристика исследования
- Дизайн
- single-center retrospective case-control study (Indiana University Health Methodist Hospital, Indianapolis, June 2019-June 2020)
- Размер выборки (n)
- 42
- Вмешательство
- Bivalirudin therapeutic anticoagulation in COVID-19 ARDS patients on venovenous ECMO (n=19)
- Компаратор
- Bivalirudin anticoagulation in non-COVID ARDS ECMO patients (n=23)
- Первичная конечная точка
- Time at goal activated partial thromboplastin time (aPTT) and bivalirudin dose requirements
- Основной результат
- COVID-19 ECMO patients maintained goal aPTT more consistently (86% vs 74%, p<0.01); required higher median daily bivalirudin (3.1 vs 2.4 μg/kg/min, p=0.05); no difference in bleeding or thrombosis between groups
- Длительность наблюдения
- ECMO run duration
- PMID
- 34782234
Ключевые выводы
- COVID-19 ECMO required ~30% higher daily bivalirudin doses than non-COVID controls
- Goal aPTT maintained more consistently in COVID-19 patients (86% vs 74%)
- No difference in bleeding or thrombotic complications between cohorts
- Suggests COVID-19 hypercoagulability alters bivalirudin dosing requirements
- Supports bivalirudin as feasible anticoagulant in COVID-19 ECMO
Ограничения
- Retrospective single-center design
- Small sample size (n=42) limits subgroup analysis
- Confounded by COVID-19 era practice changes
- Case-control rather than RCT
- Not applicable to whole-leech hirudotherapy
Клиническое значение
Trigonis 2021 anchors COVID-19 era ECMO bivalirudin dosing precedent. For ASH, the case-control study reinforces that the pharmaceutical thrombin inhibitor pathway operates under retrospective hypothesis-generating evidence in critical care, structurally distinct from the K040187 device-leech US clinical practice for venous congestion. The COVID-19 hypercoagulability finding has no direct parallel in routine hirudotherapy applications.
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)
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)
Comparison of Bivalirudin Versus Heparin for Anticoagulation During Extracorporeal Membrane Oxygenation
Hasegawa D, Sato R, Prasitlumkum N, Nishida K, Keaton B, Acquah SO, Im Lee Y (2022)