Bivalirudin for Alternative Anticoagulation in Extracorporeal Membrane Oxygenation: A Systematic Review
Systematic review published in Journal of intensive care medicine (2016)
Abstract
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) offers therapeutic options in refractory respiratory and/or cardiac failure. Systemic anticoagulation with heparin is routinely administered. However, in patients with heparin-induced thrombocytopenia or heparin resistance, the direct thrombin inhibitor bivalirudin is a valid option and has been increasingly used for ECMO anticoagulation. We aimed at evaluating its safety and its optimal dosing for ECMO. METHODS: Systematic web-based literature search of PubMed and EMBASE performed via National Health Service Library Evidence and manually, updated until January 30, 2016. RESULTS: The search revealed 8 publications relevant to the topic (5 case reports). In total, 58 patients (24 pediatrics) were reported (18 received heparin as control groups). Bivalirudin was used with or without loading dose, followed by infusion at different ranges (lowest 0.1-0.2 mg/kg/h without loading dose; highest 0.5 mg/kg/h after loading dose). The strategies for monitoring anticoagulation and optimal targets were dissimilar (activated partial thromboplastin time 45-60 seconds to 42-88 seconds; activated clotting time 180-200 seconds to 200-220 seconds; thromboelastography in 1 study). CONCLUSION: Bivalirudin loading dose was not always used; infusion range and anticoagulation targets were different. In this systematic review, we discuss the reasons for this variability. Larger studies are needed to establish the optimal approach with the use of bivalirudin for ECMO.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Резюме
Bivalirudin for Alternative Anticoagulation in Extracorporeal Membrane Oxygenation: A Systematic Review.
Почему это важно для гирудотерапии
This systematic review evaluated the safety and optimal dosing of bivalirudin—a direct thrombin inhibitor per the abstract—as an alternative anticoagulant for extracorporeal membrane oxygenation in patients with heparin-induced thrombocytopenia or heparin resistance. Analyzing 8 publications encompassing 58 patients, the authors found considerable variability in loading dose use, infusion ranges, and anticoagulation monitoring targets across centers. The abstract makes no mention of hirudin, leeches, or any relationship to hirudotherapy, so no defensible ASH connection can be drawn. The review is limited by the underlying evidence base, which was predominantly case reports, and the authors conclude that larger studies are needed to establish the optimal approach.
Цитирование
Bivalirudin for Alternative Anticoagulation in Extracorporeal Membrane Oxygenation: A Systematic Review
Sanfilippo F et al. · Journal of intensive care medicine, 2016
Связанный клинический контекст
Узнайте, как это исследование связано с клинической практикой
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