PMID- 35412480
OWN - NLM
STAT- MEDLINE
DCOM- 20230106
LR  - 20230217
IS  - 1538-943X (Electronic)
IS  - 1058-2916 (Linking)
VI  - 69
IP  - 1
DP  - 2023 Jan 1
TI  - Bivalirudin Versus Unfractionated Heparin in Patients With Cardiogenic Shock 
      Requiring Venoarterial Extracorporeal Membrane Oxygenation.
PG  - 107-113
LID - 10.1097/MAT.0000000000001723 [doi]
AB  - This study evaluated differences in efficacy and safety outcomes with bivalirudin 
      compared with unfractionated heparin (UFH) in patients with cardiogenic shock 
      requiring venoarterial extracorporeal membrane oxygenation (VA ECMO). We 
      performed a retrospective study at an academic medical center that included 
      patients greater than 18 years of age supported with VA ECMO due to cardiogenic 
      shock from January 2009 to February 2021. The primary endpoint was 
      ECMO-associated thrombotic events normalized to duration of ECMO support. 
      Secondary safety endpoints included major bleeding (per ELSO criteria) and blood 
      product administration. Overall, 143 patients were included in our analysis with 
      54 having received bivalirudin and 89 having received UFH. Median duration of 
      ECMO support was 92 (interquartile range, 56-172) hours. ECMO-associated 
      thrombotic events per ECMO day were significantly less among those that received 
      bivalirudin ( P < 0.001). In adjusted regression, bivalirudin was independently 
      associated with an increased time to thrombosis when compared with UFH (Exp[B] 
      -3.8; 95% confidence interval, 1.7-8.8; P = 0.002). Patients receiving 
      bivalirudin experienced less major bleeding events ( P = 0.02) with less total 
      red blood cell and fresh frozen plasma administration ( P = 0.04 and P = 0.03, 
      respectively). Bivalirudin is a safe and efficacious alternative to UFH in 
      patients requiring VA ECMO for cardiogenic shock.
CI  - Copyright (c) ASAIO 2022.
FAU - Uricchio, Marissa N
AU  - Uricchio MN
AUID- ORCID: 0000-0002-1394-1665
AD  - From the Department of Pharmacy, UPMC Presbyterian-Shadyside, Pittsburgh, 
      Pennsylvania.
FAU - Ramanan, Raj
AU  - Ramanan R
AD  - Department of Cardiothoracic Critical Care, UPMC Presbyterian-Shadyside, 
      Pittsburgh, Pennsylvania.
AD  - Department of Critical Care Medicine, University of Pittsburgh School of 
      Medicine, Pittsburgh, Pennsylvania.
FAU - Esper, Stephen A
AU  - Esper SA
AUID- ORCID: 0000-0003-4839-8030
AD  - Department of Anesthesiology and Perioperative Medicine, UPMC 
      Presbyterian-Shadyside, University of Pittsburgh School of Medicine, Pittsburgh, 
      Pennsylvania.
FAU - Murray, Holt
AU  - Murray H
AD  - Department of Cardiothoracic Critical Care, UPMC Presbyterian-Shadyside, 
      Pittsburgh, Pennsylvania.
AD  - Department of Critical Care Medicine, University of Pittsburgh School of 
      Medicine, Pittsburgh, Pennsylvania.
FAU - Kaczorowski, David J
AU  - Kaczorowski DJ
AD  - Department of Cardiothoracic Surgery, UPMC Presbyterian-Shadyside, Pittsburgh, 
      Pennsylvania.
FAU - D'Aloiso, Brandon
AU  - D'Aloiso B
AUID- ORCID: 0000-0003-0710-389
AD  - Department of Cardiovascular Perfusion, UPMC Presbyterian-Shadyside, Pittsburgh, 
      Pennsylvania.
FAU - Gomez, Hernando
AU  - Gomez H
AD  - Department of Cardiothoracic Critical Care, UPMC Presbyterian-Shadyside, 
      Pittsburgh, Pennsylvania.
AD  - Department of Critical Care Medicine, University of Pittsburgh School of 
      Medicine, Pittsburgh, Pennsylvania.
FAU - Sciortino, Christopher
AU  - Sciortino C
AD  - Sentara Mid-Atlantic Cardiothoracic Surgeons, Norfolk, Virginia.
FAU - Sanchez, Pablo G
AU  - Sanchez PG
AUID- ORCID: 0000-0003-3607-0345
AD  - Department of Thoracic Surgery, UPMC Presbyterian-Shadyside, Pittsburgh, 
      Pennsylvania.
FAU - Sappington, Penny L
AU  - Sappington PL
AD  - Department of Transplant Critical Care Medicine, WVU Medicine, Morgantown, West 
      Virginia.
AD  - Department of Critical Care Medicine, West Virginia University School of 
      Medicine, Morgantown, West Virginia.
FAU - Rivosecchi, Ryan M
AU  - Rivosecchi RM
AD  - From the Department of Pharmacy, UPMC Presbyterian-Shadyside, Pittsburgh, 
      Pennsylvania.
LA  - eng
PT  - Journal Article
DEP - 20220411
PL  - United States
TA  - ASAIO J
JT  - ASAIO journal (American Society for Artificial Internal Organs : 1992)
JID - 9204109
RN  - TN9BEX005G (bivalirudin)
RN  - 9005-49-6 (Heparin)
RN  - 0 (Antithrombins)
SB  - IM
MH  - Humans
MH  - *Extracorporeal Membrane Oxygenation/adverse effects
MH  - Hemorrhage/etiology
MH  - Heparin/therapeutic use
MH  - Retrospective Studies
MH  - *Shock, Cardiogenic/drug therapy
MH  - *Thrombosis/drug therapy/etiology
MH  - *Antithrombins/therapeutic use
COIS- Disclosure: The authors have no conflicts of interest to report.
EDAT- 2022/04/13 06:00
MHDA- 2023/01/04 06:00
CRDT- 2022/04/12 12:12
PHST- 2022/04/13 06:00 [pubmed]
PHST- 2023/01/04 06:00 [medline]
PHST- 2022/04/12 12:12 [entrez]
AID - 00002480-202301000-00021 [pii]
AID - 10.1097/MAT.0000000000001723 [doi]
PST - ppublish
SO  - ASAIO J. 2023 Jan 1;69(1):107-113. doi: 10.1097/MAT.0000000000001723. Epub 2022 
      Apr 11.