PMID- 35496287
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220716
IS  - 1663-9812 (Print)
IS  - 1663-9812 (Electronic)
IS  - 1663-9812 (Linking)
VI  - 13
DP  - 2022
TI  - The Efficacy and Safety of Bivalirudin Versus Heparin in the Anticoagulation 
      Therapy of Extracorporeal Membrane Oxygenation: A Systematic Review and 
      Meta-Analysis.
PG  - 771563
LID - 10.3389/fphar.2022.771563 [doi]
LID - 771563
AB  - Background: Bivalirudin is a direct thrombin inhibitor (DTI) that can be an 
      alternative to unfractionated heparin (UFH). The efficacy and safety of 
      bivalirudin in anticoagulation therapy in extracorporeal membrane oxygenation 
      (ECMO) remain unknown. Methods: This study followed the preferred reporting items 
      for systematic reviews and meta-analyses (PRISMA) guidelines. A systematic 
      literature search was performed in PubMed, EMBASE, and The Cochrane Library 
      databases to identify all relevant original studies estimating bivalirudin's 
      efficacy and safety versus UFH as anticoagulation therapy in ECMO. The time limit 
      for searching is from the search beginning to June 2021. Two researchers 
      independently screened the literature, extracted data and evaluated the risk of 
      bias of the included studies. The meta-analysis (CRD42020214713) was performed 
      via the RevMan version 5.3.5 Software and STATA version 15.1 Software. Results: 
      Ten articles with 847 patients were included for the quantitative analysis. 
      Bivalirudin can significantly reduce the incidence of major bleeding in children 
      (I (2) = 48%, p = 0.01, odd ratio (OR) = 0.17, 95% confidence interval (CI): 
      0.04-0.66), patient thrombosis (I (2) = 0%, p = 0.02, OR = 0.58, 95% CI: 
      0.37-0.93), in-circuit thrombosis/interventions (I (2) = 0%, p = 0.0005, OR = 
      0.40, 95% CI: 0.24-0.68), and in-hospital mortality (I (2) = 0%, p = 0.007, OR = 
      0.64, 95% CI: 0.46-0.88). Also, comparable clinical outcomes were observed in the 
      incidence of major bleeding in adults (I (2) = 48%, p = 0.65, OR = 0.87, 95% CI: 
      0.46-1.62), 30-day mortality (I (2) = 0%, p = 0.61, OR = 0.83, 95% CI: 
      0.41-1.68), and ECMO duration in adults (I (2) = 41%, p = 0.75, mean difference 
      (MD) = -3.19, 95% CI: -23.01-16.63) and children (I (2) = 76%, p = 0.65, MD = 
      40.33, 95% CI:-135.45-216.12). Conclusions: Compared with UFH, bivalirudin can be 
      a safe and feasible alternative anticoagulant option to UFH as anticoagulation 
      therapy in ECMO, especially for heparin resistance (HR) and heparin-induced 
      thrombocytopenia (HIT) cases.
CI  - Copyright (c) 2022 Ma, Liang, Zhu, Dai, Jia, Huang and He.
FAU - Ma, Min
AU  - Ma M
AD  - Department of Cardiology, West China Hospital of Sichuan University, Chengdu, 
      China.
AD  - Department of Cardiology, The Sixth People's Hospital of Chengdu, Chengdu, China.
FAU - Liang, Shichu
AU  - Liang S
AD  - Department of Cardiology, West China Hospital of Sichuan University, Chengdu, 
      China.
FAU - Zhu, Jingbo
AU  - Zhu J
AD  - Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong 
      University of Science and Technology, Wuhan, China.
FAU - Dai, Manyu
AU  - Dai M
AD  - Department of Cardiology, The First Affiliated Hospital of Anhui Medical 
      University, Hefei, China.
FAU - Jia, Zhuoran
AU  - Jia Z
AD  - Department of Cardiology, The First Affiliated Hospital of Anhui Medical 
      University, Hefei, China.
FAU - Huang, He
AU  - Huang H
AD  - Department of Cardiology, West China Hospital of Sichuan University, Chengdu, 
      China.
FAU - He, Yong
AU  - He Y
AD  - Department of Cardiology, West China Hospital of Sichuan University, Chengdu, 
      China.
LA  - eng
PT  - Journal Article
DEP - 20220414
PL  - Switzerland
TA  - Front Pharmacol
JT  - Frontiers in pharmacology
JID - 101548923
PMC - PMC9048024
OTO - NOTNLM
OT  - bivalirudin
OT  - extracorporeal membrane oxygenation
OT  - heparin
OT  - meta-analysis
OT  - systematic review
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- 2022/05/03 06:00
MHDA- 2022/05/03 06:01
PMCR- 2022/04/14
CRDT- 2022/05/02 06:48
PHST- 2021/10/01 00:00 [received]
PHST- 2022/03/29 00:00 [accepted]
PHST- 2022/05/02 06:48 [entrez]
PHST- 2022/05/03 06:00 [pubmed]
PHST- 2022/05/03 06:01 [medline]
PHST- 2022/04/14 00:00 [pmc-release]
AID - 771563 [pii]
AID - 10.3389/fphar.2022.771563 [doi]
PST - epublish
SO  - Front Pharmacol. 2022 Apr 14;13:771563. doi: 10.3389/fphar.2022.771563. 
      eCollection 2022.