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
Hirulog in the treatment of unstable angina. Results of the Thrombin Inhibition in Myocardial Ischemia (TIMI) 7 trial
Fuchs J, Cannon CP (1995)
Bivalirudin in patients undergoing primary angioplasty for acute myocardial infarction (HORIZONS-AMI): 1-year results of a randomised controlled trial
Mehran R, Lansky AJ, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Dudek D, Kornowski R, Hartmann F, Gersh BJ, Pocock SJ, Wong SC, Nikolsky E, Gambone L, Vandertie L, Parise H, Dangas GD, Stone GW (2009)
Experience with pharmacologic leeching with bivalirudin for adjunct treatment of venous congestion of head and neck reconstructive flaps
Harun A, Kruer RM, Lee A, Boahene K, Byrne PJ, Richmon JD (2018)
Heparin and Bivalirudin in Percutaneous Coronary Intervention for Acute Coronary Syndromes: A Review Article
Wang G, Qi K, Li X, Zuo S, Zhang R, Zhao Y, Sun S, Zhang J, Liu X (2024)