Bivalirudin for Alternative Anticoagulation in Extracorporeal Membrane Oxygenation: A Systematic Review

Filippo Sanfilippo, Sven Asmussen, Dirk M Maybauer, Cristina Santonocito, John F Fraser, Gabor Erdoes, Marc O Maybauer

Research output: Contribution to journalArticle

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.

Original languageEnglish
JournalJournal of Intensive Care Medicine
DOIs
Publication statusE-pub ahead of print - Jun 29 2016

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Extracorporeal Membrane Oxygenation
Heparin
Thrombelastography
Antithrombins
Partial Thromboplastin Time
National Health Programs
PubMed
Respiratory Insufficiency
Thrombocytopenia
Libraries
Publications
Heart Failure
Pediatrics
Safety
Control Groups
bivalirudin
Therapeutics

Keywords

  • Journal Article

Cite this

Sanfilippo, F., Asmussen, S., Maybauer, D. M., Santonocito, C., Fraser, J. F., Erdoes, G., & Maybauer, M. O. (2016). Bivalirudin for Alternative Anticoagulation in Extracorporeal Membrane Oxygenation: A Systematic Review. Journal of Intensive Care Medicine. https://doi.org/10.1177/0885066616656333

Bivalirudin for Alternative Anticoagulation in Extracorporeal Membrane Oxygenation : A Systematic Review. / Sanfilippo, Filippo; Asmussen, Sven; Maybauer, Dirk M; Santonocito, Cristina; Fraser, John F; Erdoes, Gabor; Maybauer, Marc O.

In: Journal of Intensive Care Medicine, 29.06.2016.

Research output: Contribution to journalArticle

Sanfilippo, Filippo ; Asmussen, Sven ; Maybauer, Dirk M ; Santonocito, Cristina ; Fraser, John F ; Erdoes, Gabor ; Maybauer, Marc O. / Bivalirudin for Alternative Anticoagulation in Extracorporeal Membrane Oxygenation : A Systematic Review. In: Journal of Intensive Care Medicine. 2016.
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AB - 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.

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