Evaluation of Bivalirudin As an Alternative to Heparin for Systemic Anticoagulation in Pediatric Extracorporeal Membrane Oxygenation*
| Autor: | Mohammed Hamzah, Chidiebere Ezetendu, Angela Jarden, Robert W. Stewart |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.drug_class
medicine.medical_treatment 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine Extracorporeal law.invention 03 medical and health sciences Extracorporeal Membrane Oxygenation 0302 clinical medicine Randomized controlled trial law medicine Extracorporeal membrane oxygenation Humans Bivalirudin Child Retrospective Studies Heparin business.industry Anticoagulant Antithrombin Anticoagulants 030208 emergency & critical care medicine Hirudins Peptide Fragments Recombinant Proteins Direct thrombin inhibitor Child Preschool Anesthesia Pediatrics Perinatology and Child Health business medicine.drug |
| Zdroj: | Pediatric Critical Care Medicine. 21:827-834 |
| ISSN: | 1529-7535 |
| Popis: | Objectives Heparin is the universal anticoagulant for patients receiving extracorporeal membrane oxygenation support. However, heparin has many disadvantages, especially in young children, who develop heparin resistance. Recently our center has used bivalirudin, a direct thrombin inhibitor, for systemic anticoagulation in pediatric extracorporeal life support. Bivalirudin binds directly to thrombin with no need for antithrombin III and it inhibits both circulating and clot-bound thrombin. In this study, we sought to evaluate our experience with bivalirudin in pediatric extracorporeal life support. Design Retrospective chart review study of patients receiving extracorporeal membrane oxygenation support between October 2014 and May 2018. Setting Tertiary, academic PICU. Patients Sixteen patients receiving heparin and 16 patients receiving bivalirudin on extracorporeal life support were included in the study. Interventions None. Measurements and main results Patients in the bivalirudin group had a median age of 31 months versus 59 months in the heparin group (p = 0.41). Recovery and extracorporeal membrane oxygenation decannulation were similar in both groups (56% in the heparin group and 62% in the bivalirudin group; p = 0.62). Time to reach goal therapeutic anticoagulation level was shorter in the bivalirudin group (11 vs 29 hr; p = 0.01). Bleeding events were fewer in the bivalirudin group, and there was no difference in the rate of thrombotic events between the two groups. Comprehensive cost analysis that includes anticoagulant, laboratories, and antithrombin III cost, showed that heparin anticoagulation therapy total cost was significantly higher than bivalirudin (1,184 dollars per day in heparin group vs 494 dollars per day in bivalirudin group; p = 0.03). Bivalirudin dose required to maintain target anticoagulation will increase over time, and this is associated with an increase in creatinine clearance and an increase in fibrinogen serum levels. Conclusions This study showed that the use of bivalirudin in pediatric extracorporeal membrane oxygenation support is feasible, safe, reliable, and cost-effective in comparison to heparin. Further prospective randomized clinical trials are necessary to confirm our observations. |
| Databáze: | OpenAIRE |
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