Bivalirudin Versus Unfractionated Heparin in Patients With Cardiogenic Shock Requiring Venoarterial Extracorporeal Membrane Oxygenation.

Autor:	Uricchio MN; From the Department of Pharmacy, UPMC Presbyterian-Shadyside, Pittsburgh, Pennsylvania., Ramanan R; Department of Cardiothoracic Critical Care, UPMC Presbyterian-Shadyside, Pittsburgh, Pennsylvania.; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Esper SA; Department of Anesthesiology and Perioperative Medicine, UPMC Presbyterian-Shadyside, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Murray H; Department of Cardiothoracic Critical Care, UPMC Presbyterian-Shadyside, Pittsburgh, Pennsylvania.; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Kaczorowski DJ; Department of Cardiothoracic Surgery, UPMC Presbyterian-Shadyside, Pittsburgh, Pennsylvania., D'Aloiso B; Department of Cardiovascular Perfusion, UPMC Presbyterian-Shadyside, Pittsburgh, Pennsylvania., Gomez H; Department of Cardiothoracic Critical Care, UPMC Presbyterian-Shadyside, Pittsburgh, Pennsylvania.; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Sciortino C; Sentara Mid-Atlantic Cardiothoracic Surgeons, Norfolk, Virginia., Sanchez PG; Department of Thoracic Surgery, UPMC Presbyterian-Shadyside, Pittsburgh, Pennsylvania., Sappington PL; Department of Transplant Critical Care Medicine, WVU Medicine, Morgantown, West Virginia.; Department of Critical Care Medicine, West Virginia University School of Medicine, Morgantown, West Virginia., Rivosecchi RM; From the Department of Pharmacy, UPMC Presbyterian-Shadyside, Pittsburgh, Pennsylvania.
Jazyk:	angličtina
Zdroj:	ASAIO journal (American Society for Artificial Internal Organs : 1992) [ASAIO J] 2023 Jan 01; Vol. 69 (1), pp. 107-113. Date of Electronic Publication: 2022 Apr 11.
DOI:	10.1097/MAT.0000000000001723
Abstrakt:	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. Competing Interests: Disclosure: The authors have no conflicts of interest to report. (Copyright © ASAIO 2022.)
Databáze:	MEDLINE
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