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) · Frontiers in Medicine · n=313
Характеристика исследования
- Дизайн
- systematic review of seven retrospective cohort studies (PubMed, Cochrane Library, Embase through October 2022)
- Размер выборки (n)
- 313
- Вмешательство
- Bivalirudin anticoagulation in pediatric ECMO (n=117 pooled)
- Компаратор
- Heparin anticoagulation in pediatric ECMO (n=196 pooled)
- Первичная конечная точка
- Bleeding events, thrombotic complications, transfusion requirements, mortality
- Основной результат
- Bivalirudin trended toward lower bleeding, transfusion requirements, and thrombosis; no mortality difference; bivalirudin associated with lower overall costs; time to therapeutic anticoagulation variable between studies
- Длительность наблюдения
- ECMO run + hospital course
- PMID
- 36999064
Ключевые выводы
- Pediatric-specific pooled analysis (n=313) of bivalirudin vs heparin
- Trends toward lower bleeding and thrombosis with bivalirudin
- Lower transfusion requirements with bivalirudin
- Lower overall pharmacologic costs with bivalirudin
- No mortality signal in either direction
Ограничения
- All 7 included studies retrospective
- Heterogeneous anticoagulation targets across institutions
- Small sample sizes in individual studies
- Cannot adjust for unmeasured confounders
- Not applicable to whole-leech hirudotherapy
Клиническое значение
Valdes 2023 provides a pediatric-specific evidence summary supporting bivalirudin as a feasible heparin alternative in children on ECMO. For ASH, the systematic review confirms the pediatric pharmaceutical pathway operates under retrospective signal-generation distinct from device-leech K040187 US clinical practice. The cost-effectiveness signal supports pharmaceutical pathway scaling under specific clinical scenarios.
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)