Evaluation of direct thrombin inhibitors during a critical heparin shortage

Ji, Christine; Roberts, Russel J.; Barra, Megan E.; Lee, Hang; Rosovsky, Rachel

doi:10.1007/s11239-020-02357-4

Cited by 1 publication

(2 citation statements)

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“…The median SAVE score was −9 [−12 to −5] and RESP score was 0 [−2 to 1]. Median duration on ECMO support was 9 [6][7][8][9][10][11][12][13] days and time on bivalirudin while on ECMO was 4 [1][2][3][4][5][6][7][8][9][10][11] days. Seventeen (71%) patients had acute kidney injury and 11 (46%) patients received continuous venovenous hemofiltration (CVVH) while on ECMO support.…”

Section: Resultsmentioning

confidence: 99%

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Evaluation of Bivalirudin During Adult Extracorporeal Membrane Oxygenation: A Retrospective Characterization of Dosing, Efficacy and Bleeding

et al. 2023

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Objective: Although heparin is the current standard anticoagulant during venoarterial (VA) and venovenous (VV) extracorporeal membrane oxygenation (ECMO), factors including heparin-induced thrombocytopenia, heparin resistance and drug shortages necessitate alternative anticoagulants such as direct thrombin inhibitors. The aim was to characterize dosing, safety, and efficacy of bivalirudin during ECMO support. Methods: This retrospective single-center study included 24 adults on ECMO support who received ≥6 hours of bivalirudin. The primary endpoint was dose to first therapeutic activated partial thromboplastin time (aPTT). Secondary endpoints included evaluating dosing between ECMO modes, incidence of bleeding and thrombotic events, and time in therapeutic range (TTR). Results: The dose at time of first therapeutic aPTT was bivalirudin 0.05 [0.05-0.1] mg/kg/hour. Bivalirudin dosing requirements were lower in VAECMO compared to VV-ECMO patients and were not impacted by continuous venovenous hemofiltration. Time to therapeutic aPTT was 5.5 [2-13] hours for VA-ECMO and 4.5 [2-8.6] hours for VV-ECMO patients. During any mode of ECMO TTR was 58.3% [39.6-73.1]. Thrombotic events occurred in 3 (13%) patients and major bleeding occurred in 12 (50%) patients. Conclusions: Our findings demonstrated variable bivalirudin dosing requirements based on mode of ECMO and dosing modifications may not be required during CVVH. Factors including mode of ECMO, indication for bivalirudin and concomitant antiplatelet therapy may impact hematologic events. Application of this data can assist with developing a bivalirudin ECMO protocol which provides less variability in initial dosing and TTR.

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Section: Resultsmentioning

confidence: 99%

“…11 Bivalirudin became the preferred anticoagulant during VA and venovenous (VV) ECMO support resulting in higher utilization during this time. 12 Due to the limited evidence surrounding DTI-based anticoagulation in adult ECMO, we aimed to characterize the dosage, efficacy, and safety profiles of bivalirudin in this patient population.…”

Section: Introductionmentioning

confidence: 99%