PMID- 34540910 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20210921 IS - 2297-055X (Print) IS - 2297-055X (Electronic) IS - 2297-055X (Linking) VI - 8 DP - 2021 TI - Pediatric Mechanical Circulatory Support: Pathophysiology of Pediatric Hemostasis and Available Options. PG - 671241 LID - 10.3389/fcvm.2021.671241 [doi] LID - 671241 AB - Pediatric mechanical circulatory support (MCS) is considered a strategy for heart failure management as a bridge to recovery and transplantation or as a destination therapy. The final outcome is significantly impacted by the number of complications that may occur during MCS. Children on ventricular assist devices (VADs) and extracorporeal membrane oxygenation (ECMO) are at high risk for bleeding and thrombotic complications that are managed through anticoagulation. The first detailed guideline in pediatric VADs (Edmonton Anticoagulation and Platelet Inhibition Protocol) was based on conventional antithrombotic drugs, such as unfractionated heparin (UFH) and warfarin. UFH is the first-line anticoagulant in pediatric MCS, although its profile is not considered optimal in pediatric setting. The broad variation in heparin doses among children is associated with frequent occurrence of cerebrovascular accidents, bleeding, and thrombocytopenia. Direct thrombin inhibitors (DTIs) have been utilized as alternative strategies to heparin. Since 2018, bivalirudin has become the chosen anticoagulant in the long-term therapy of patients undergoing MCS implantation, according to the most recent protocols shared in North America. This article provides a review of the non-traditional anticoagulation strategies utilized in pediatric MCS, focusing on pharmacodynamics, indications, doses, and monitoring aspects of bivalirudin. Moreover, it exposes the efforts and the collaborations among different specialized centers, which are committed to an ongoing learning in order to minimize major complications in this special pediatric population. Further prospective trials regarding DTIs in a pediatric MCS setting are necessary and in specific well-designed randomized control trials between UFH and bivalirudin. To conclude, based on the reported literature, the clinical use of the bivalirudin in pediatric MCS seems to be a value added in controlling and maybe reducing thromboembolic complications. Further research is necessary to confirm all the results provided by this literature review. CI - Copyright (c) 2021 Giorni, Rizza, Favia, Amodeo, Chiusolo, Picardo, Luciani, Di Felice and Di Chiara. FAU - Giorni, Chiara AU - Giorni C AD - Pediatric Cardiac Intensive Care Unit, Department of Cardiology and Cardiac Surgery, Bambino Gesu Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy. FAU - Rizza, Alessandra AU - Rizza A AD - Pediatric Cardiac Intensive Care Unit, Department of Cardiology and Cardiac Surgery, Bambino Gesu Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy. FAU - Favia, Isabella AU - Favia I AD - Pediatric Cardiac Intensive Care Unit, Department of Cardiology and Cardiac Surgery, Bambino Gesu Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy. FAU - Amodeo, Antonio AU - Amodeo A AD - Mechanical Circulatory Support Unit, Department of Cardiology and Cardiac Surgery, Bambino Gesu Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy. FAU - Chiusolo, Fabrizio AU - Chiusolo F AD - Department of Anesthesia and Critical Care, Anestesia Rianimazione Comparto Operatorio, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy. FAU - Picardo, Sergio G AU - Picardo SG AD - Department of Anesthesia and Critical Care, Anestesia Rianimazione Comparto Operatorio, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy. FAU - Luciani, Matteo AU - Luciani M AD - Department of Oncohematology, Haemostasis and Thrombosis Center, Bambino Gesu Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy. FAU - Di Felice, Giovina AU - Di Felice G AD - Hemostasis Laboratory, Bambino Gesu Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy. FAU - Di Chiara, Luca AU - Di Chiara L AD - Pediatric Cardiac Intensive Care Unit, Department of Cardiology and Cardiac Surgery, Bambino Gesu Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy. LA - eng PT - Journal Article PT - Review DEP - 20210901 PL - Switzerland TA - Front Cardiovasc Med JT - Frontiers in cardiovascular medicine JID - 101653388 PMC - PMC8440876 OTO - NOTNLM OT - anticoagulation OT - bivalirudin OT - bleeding OT - heparin OT - mechanical circulatory support OT - pediatrics OT - quality improvement OT - thrombosis COIS- The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. EDAT- 2021/09/21 06:00 MHDA- 2021/09/21 06:01 PMCR- 2021/01/01 CRDT- 2021/09/20 06:14 PHST- 2021/03/17 00:00 [received] PHST- 2021/06/17 00:00 [accepted] PHST- 2021/09/20 06:14 [entrez] PHST- 2021/09/21 06:00 [pubmed] PHST- 2021/09/21 06:01 [medline] PHST- 2021/01/01 00:00 [pmc-release] AID - 10.3389/fcvm.2021.671241 [doi] PST - epublish SO - Front Cardiovasc Med. 2021 Sep 1;8:671241. doi: 10.3389/fcvm.2021.671241. eCollection 2021.