PMID- 34669620
OWN - NLM
STAT- MEDLINE
DCOM- 20220630
LR  - 20230821
IS  - 1538-943X (Electronic)
IS  - 1058-2916 (Linking)
VI  - 68
IP  - 7
DP  - 2022 Jul 1
TI  - Comparison of Bivalirudin Versus Unfractionated Heparin for Anticoagulation in 
      Adult Patients on Extracorporeal Membrane Oxygenation.
PG  - 920-924
LID - 10.1097/MAT.0000000000001598 [doi]
AB  - Extracorporeal membrane oxygenation (ECMO) contributes to coagulopathy, 
      necessitating systemic anticoagulation to prevent thrombosis. Traditionally, 
      unfractionated heparin (UFH) has been the anticoagulant of choice, however, due 
      to many inadequacies new evidence suggests benefit with the use of direct 
      thrombin inhibitors. This retrospective cohort sought to evaluate the safety and 
      efficacy of bivalirudin compared to UFH in ECMO patients. Primary endpoints 
      included incidence of bleeding and thrombosis. Percent time in therapeutic range 
      (TR), time to achieve TR and number of dose titrations required to maintain TR 
      were calculated to assess efficacy of institutional protocols. Overall incidence 
      of thrombosis was low, with one event in the bivalirudin group and no events in 
      the UFH group. No difference was found in rates of bleeding between groups (6% vs 
      . 10%, P = 0.44). Bivalirudin yielded higher percent time in TR (86% vs. 33%, P < 
      0.001), faster time to TR (2 vs . 18 hr, P < 0.001) and required fewer dose 
      adjustments to maintain TR (2 vs . 11, P < 0.001) compared to UFH. These results 
      suggest bivalirudin and UFH are associated with similar rates of bleeding and 
      thrombosis in patients requiring ECMO support. Our results demonstrate the 
      favorable pharmacokinetic profile of bivalirudin, and its ability to consistently 
      maintain TR when compared to UFH.
CI  - Copyright (c) ASAIO 2021.
FAU - Sheridan, Erica A
AU  - Sheridan EA
AUID- ORCID: 0000-0001-5434-4560
AD  - From the Department of Pharmacy Services, ProMedica Toledo Hospital, Toledo, 
      Ohio.
FAU - Sekela, Michael E
AU  - Sekela ME
AD  - Division of Cardiothoracic Surgery, University of Kentucky Healthcare, Lexington, 
      Kentucky.
FAU - Pandya, Komal A
AU  - Pandya KA
AD  - Department of Pharmacy Services, University of Kentucky Healthcare, Lexington, 
      Kentucky.
AD  - College of Pharmacy, University of Kentucky, Lexington, Kentucky.
FAU - Schadler, Aric
AU  - Schadler A
AUID- ORCID: 0000-0001-8814-5834
AD  - College of Pharmacy, University of Kentucky, Lexington, Kentucky.
AD  - Kentucky Children's Hospital, University of Kentucky Healthcare, Lexington, 
      Kentucky, USA.
FAU - Ather, Ayesha
AU  - Ather A
AD  - Department of Pharmacy Services, University of Kentucky Healthcare, Lexington, 
      Kentucky.
AD  - College of Pharmacy, University of Kentucky, Lexington, Kentucky.
LA  - eng
PT  - Journal Article
DEP - 20221019
PL  - United States
TA  - ASAIO J
JT  - ASAIO journal (American Society for Artificial Internal Organs : 1992)
JID - 9204109
RN  - 0 (Anticoagulants)
RN  - 0 (Antithrombins)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Adult
MH  - Anticoagulants/adverse effects/therapeutic use
MH  - Antithrombins/therapeutic use
MH  - *Extracorporeal Membrane Oxygenation/adverse effects
MH  - Fibrinolytic Agents/therapeutic use
MH  - Hemorrhage/chemically induced/complications/prevention & control
MH  - Heparin/adverse effects/therapeutic use
MH  - Hirudin Therapy
MH  - Hirudins/adverse effects
MH  - Humans
MH  - Peptide Fragments/adverse effects/therapeutic use
MH  - Recombinant Proteins/adverse effects/therapeutic use
MH  - Retrospective Studies
MH  - *Thrombosis/drug therapy/etiology/prevention & control
MH  - Treatment Outcome
COIS- Disclosure: The authors have no financial or conflicts of interest to report.
EDAT- 2021/10/21 06:00
MHDA- 2022/07/01 06:00
CRDT- 2021/10/20 17:22
PHST- 2021/10/21 06:00 [pubmed]
PHST- 2022/07/01 06:00 [medline]
PHST- 2021/10/20 17:22 [entrez]
AID - 00002480-202207000-00007 [pii]
AID - 10.1097/MAT.0000000000001598 [doi]
PST - ppublish
SO  - ASAIO J. 2022 Jul 1;68(7):920-924. doi: 10.1097/MAT.0000000000001598. Epub 2022 
      Oct 19.