title: Bivalirudin versus heparin as an anticoagulant during extracorporeal membrane oxygenation: a case-control study.
abstract: OBJECTIVE
  Heparin-based anticoagulation for patients undergoing extracorporeal membrane oxygenation has many limitations, including a high risk of heparin-induced thrombocytopenia. However, little experience with other anticoagulants in these patients has been described. The aim of this study was to compare bivalirudin-based anticoagulation with heparin-based protocols in a population of patients treated with venovenous or venoarterial extracorporeal membrane oxygenation.
  
  
  METHODS
  In this case-control study, 10 patients received bivalirudin (cases) and 10 heparin (controls). The target activated partial thromboplastin time (aPTT) was 45 to 60 seconds.
  
  
  METHODS
  None.
  
  
  RESULTS
  aPTT variations >20% of the previous value were much more frequent in patients treated with heparin than in patients receiving bivalirudin (52 v 24, p < 0.001). The number of corrections of the anticoagulant dose was higher in the heparin group compared with the bivalirudin group (58 v 51), although it did not reach statistical significance. Bleeding, thromboembolic complications, extracorporeal membrane oxygenation (ECMO) support duration, mortality, and the number of episodes of aPTT >80 seconds were not different between the 2 groups. A further analysis was performed in the bivalirudin group according to the presence of acute renal failure requiring continuous venovenous hemofiltration. The median bivalirudin dose in patients with or without hemofiltration was 0.041 (0.028-0.05) mg/kg/h and 0.028 (0-0.041) mg/kg/h, respectively (p = 0.2).
  
  
  CONCLUSIONS
  Bivalirudin-based anticoagulation may represent a new method of anticoagulation for reducing thromboembolic and bleeding complications, which still jeopardize the application of extracorporeal membrane oxygenation. Moreover, bivalirudin is free from the risk of heparin-induced thrombocytopenia. Higher doses of bivalirudin may be needed in patients undergoing hemofiltration.
authors.affiliation: Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, San Raffaele Scientific Institute, Università Vita-Salute, Milan, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Pieri
authors.forename: Natalia
authors.initials: N
authors.lastname: Agracheva
authors.forename: Enrico
authors.initials: E
authors.lastname: Bonaveglio
authors.forename: Teresa
authors.initials: T
authors.lastname: Greco
authors.forename: Michele
authors.initials: M
authors.lastname: De Bonis
authors.forename: Remo Daniel
authors.initials: RD
authors.lastname: Covello
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
authors.forename: Federico
authors.initials: F
authors.lastname: Pappalardo
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D000991:Antithrombins / Q000008:administration & dosage*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D016022:Case-Control Studies; D015331:Cohort Studies; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006629:Hirudins / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time / Q000379:methods; D010446:Peptide Fragments / Q000008:administration & dosage*; D011994:Recombinant Proteins / Q000008:administration & dosage; D012189:Retrospective Studies
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin