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

Sanfilippo, Filippo; Asmussen, Sven; Maybauer, Dirk M; Santonocito, Cristina; Fraser, John F; Erdös, Gabor; Maybauer, Marc O (2016). Bivalirudin for Alternative Anticoagulation in Extracorporeal Membrane Oxygenation: A Systematic Review. Journal of intensive care medicine, 32(5), pp. 312-319. Sage 10.1177/0885066616656333

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy

UniBE Contributor:

Erdös, Gabor

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1525-1489

Publisher:

Sage

Language:

English

Submitter:

Jeannie Wurz

Date Deposited:

12 Jul 2016 08:43

Last Modified:

23 Jan 2018 12:13

Publisher DOI:

10.1177/0885066616656333

PubMed ID:

27356945

Uncontrolled Keywords:

ECMO; HIT; cardiopulmonary bypass; direct thrombin inhibitor; heparin-induced thrombocytopenia

URI:

https://boris.unibe.ch/id/eprint/84122

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