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Case Reports
. 2019 Mar;51(1):26-28.

Bivalirudin Anticoagulation for an Infant with Hyperbilirubinemia and Elevated Plasma-Free Hemoglobin on ECMO

Chidiebere Ezetendu  1 , Angela Jarden  2 , Mohammed Hamzah  1 , Robert Stewart  3
Affiliations
Case Reports

Bivalirudin Anticoagulation for an Infant with Hyperbilirubinemia and Elevated Plasma-Free Hemoglobin on ECMO

Chidiebere Ezetendu et al. J Extra Corpor Technol. 2019 Mar.

Abstract

Heparin has been used for decades as an anticoagulant in patients on mechanical circulatory support, which includes extracorporeal membrane oxygenation (ECMO) and ventricular assist devices. Bivalirudin is a direct thrombin inhibitor that can be used as an alternative anticoagulant in neonates and infants demonstrating inaccurate heparin monitoring. We report a case of a 2-month-old male child who was placed on ECMO for severe acute respiratory distress syndrome. His ECMO course was complicated by severe hemolysis and hyperbilirubinemia, which precluded accurate monitoring of heparin activity. Bivalirudin was successfully used for anticoagulation in this patient.

Keywords: bivalirudin; extracorporeal membrane oxygenation; heparin; heparin anti-Xa level; partial thromboplastin time.

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Figures

Figure 1.
Figure 1.
Anticoagulation values on ECMO.
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