Comparison of Anticoagulation Strategies in Patients Requiring Venovenous Extracorporeal Membrane Oxygenation: Heparin Versus Bivalirudin.

Autor:	Rivosecchi RM; Department of Pharmacy and Therapeutics, University of Pittsburgh Medical Center, Pittsburgh, PA., Arakelians AR; Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA., Ryan J; Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA., Murray H; Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA., Ramanan R; Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA., Gomez H; Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.; Center for Critical Care Nephrology and the CRISMA Center, University of Pittsburgh, Pittsburgh, PA., Phillips D; Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA., Sciortino C; Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA., Arlia P; Perfusion Services, University of Pittsburgh Medical Center, Pittsburgh, PA., Freeman D; Perfusion Services, University of Pittsburgh Medical Center, Pittsburgh, PA., Sappington PL; Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV., Sanchez PG; Department of Pharmacy and Therapeutics, University of Pittsburgh Medical Center, Pittsburgh, PA.
Jazyk:	angličtina
Zdroj:	Critical care medicine [Crit Care Med] 2021 Jul 01; Vol. 49 (7), pp. 1129-1136.
DOI:	10.1097/CCM.0000000000004944
Abstrakt:	Objectives: Extracorporeal membrane oxygenation is a life-sustaining therapy for severe respiratory failure. Extracorporeal membrane oxygenation circuits require systemic anticoagulation that creates a delicate balance between circuit-related thrombosis and bleeding-related complications. Although unfractionated heparin is most widely used anticoagulant, alternative agents such as bivalirudin have been used. We sought to compare extracorporeal membrane oxygenation circuit thrombosis and bleeding-related outcomes in respiratory failure patients receiving either unfractionated heparin or bivalirudin for anticoagulation on venovenous extracorporeal membrane oxygenation support. Design: Retrospective cohort study. Setting: Single-center, cardiothoracic ICU. Patients: Consecutive patients requiring venovenous extracorporeal membrane oxygenation who were maintained on anticoagulation between 2013 and 2020. Internventions: IV bivalirudin or IV unfractionated heparin. Measurements and Main Results: Primary outcomes were the presence of extracorporeal membrane oxygenation in-circuit-related thrombotic complications and volume of blood products administered during extracorporeal membrane oxygenation duration. One hundred sixty-two patients receiving unfractionated heparin were compared with 133 patients receiving bivalirudin for anticoagulation on venovenous extracorporeal membrane oxygenation. In patients receiving bivalirudin, there was an overall decrease in the number of extracorporeal membrane oxygenation circuit thrombotic complications (p < 0.005) and a significant increase in time to circuit thrombosis (p = 0.007). Multivariable Cox regression found that heparin was associated with a significant increase in risk of clots (Exp[B] = 2.31, p = 0.001). Patients who received bivalirudin received significantly less volume of packed RBCs, fresh frozen plasma, and platelet transfusion (p < 0.001 for each). There was a significant decrease in the number major bleeding events in patients receiving bivalirudin, 40.7% versus 11.7%, p < 0.001. Conclusions: Patients receiving bivalirudin for systemic anticoagulation on venovenous extracorporeal membrane oxygenation experienced a decrease in the number of extracorporeal membrane oxygenation circuit-related thrombotic events as well as a significant decrease in volume of blood products administered. Competing Interests: Dr. Gomez’s institution received funding from TES Pharma. Dr. Arlia disclosed off-label product use of extracorporeal membrane oxygenation. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)
Databáze:	MEDLINE
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