Heparin Versus Bivalirudin for Anticoagulation in Adult Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis
Wieruszewski PM, Macielak SA, Nei SD, Moman RN, Seelhammer TG, Nabzdyk CGS, Gerberi DJ, Mara KC, Hooten WM, Wittwer ED (2022) · ASAIO Journal · n=0
Характеристика исследования
- Дизайн
- systematic review and meta-analysis of 6 retrospective observational studies (5 meta-analyzable)
- Размер выборки (n)
- —
- Вмешательство
- Bivalirudin anticoagulation in adult ECMO
- Компаратор
- Heparin anticoagulation in adult ECMO
- Первичная конечная точка
- Circuit-related thrombosis, mortality, major bleeding events
- Основной результат
- Heparin associated with more circuit-related thrombosis (OR 2.05, 95% CI 1.25-3.37, p=0.005) and higher mortality (OR 1.62, 95% CI 1.19-2.21, p=0.002) vs bivalirudin; no significant difference in major bleeding (OR 1.83, p=0.33)
- Длительность наблюдения
- ECMO run + hospital discharge
- PMID
- 36355803
Ключевые выводы
- Mayo Clinic-led methodologically rigorous synthesis
- Heparin associated with 2-fold higher circuit thrombosis vs bivalirudin
- 62% higher mortality signal with heparin
- No significant difference in major bleeding events
- Uses ROBINS-I risk-of-bias tool for transparency
Ограничения
- All 6 studies retrospective observational
- Significant heterogeneity in bleeding endpoint (I²=82.7%)
- Patient selection bias likely
- Confidence intervals broad for some outcomes
- Not applicable to whole-leech hirudotherapy
Клиническое значение
Wieruszewski 2022 contributes adult-specific evidence to the bivalirudin ECMO landscape. For ASH, this meta-analysis demonstrates how rigorous methodology applied to retrospective data can produce robust signals for the synthetic thrombin inhibitor pathway, distinct from the K040187 device-leech US clinical practice. The thrombosis and mortality signals strengthen the case for prospective RCT confirmation.
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)