Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar 14:10:1137134.
doi: 10.3389/fmed.2023.1137134. eCollection 2023.

Heparin-based versus bivalirudin-based anticoagulation in pediatric extracorporeal membrane oxygenation: A systematic review

Carlos A Valdes  1 , Omar M Sharaf  1 , Mark S Bleiweis  1 , Jeffrey P Jacobs  1 , Mohammed Mumtaz  1 , Ramy M Sharaf  1 , Eric I Jeng  1 , Giles J Peek  1
Affiliations

Heparin-based versus bivalirudin-based anticoagulation in pediatric extracorporeal membrane oxygenation: A systematic review

Carlos A Valdes et al. Front Med (Lausanne). .

Abstract

Introduction: Optimal anticoagulation therapy is essential for the prevention of thrombotic and hemorrhagic complications in pediatric patients supported with extracorporeal membrane oxygenation (ECMO). Recent data have demonstrated bivalirudin has the potential to surpass and replace heparin as the anticoagulant of choice.

Methods: We conducted a systematic review comparing the outcomes of heparin-based versus bivalirudin-based anticoagulation in pediatric patients supported on ECMO to identify the preferred anticoagulant to minimize bleeding events, thrombotic complications, and associated mortality. We referenced the PubMed, Cochrane Library, and Embase databases. These databases were searched from inception through October 2022. Our initial search identified 422 studies. All records were screened by two independent reviewers using the Covidence software for adherence to our inclusion criteria, and seven retrospective cohort studies were identified as appropriate for inclusion.

Results: In total, 196 pediatric patients were anticoagulated with heparin and 117 were anticoagulated with bivalirudin while on ECMO. Across the included studies, it was found that for patients treated with bivalirudin, trends were noted toward lower rates of bleeding, transfusion requirements, and thrombosis with no difference in mortality. Overall costs associated with bivalirudin therapy were lower. Time to therapeutic anticoagulation varied between studies though institutions had different anticoagulation targets.

Conclusion: Bivalirudin may be a safe, cost-effective alternative to heparin in achieving anticoagulation in pediatric ECMO patients. Prospective multicenter studies and randomized control trials with standard anticoagulation targets are needed to accurately compare outcomes associated with heparin versus bivalirudin in pediatric ECMO patients.

Keywords: anticoagulation; bivalirudin; direct thrombin inhibitor; extracorporeal membrane oxygenation (ECMO); pediatric.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow diagram.
See this image and copyright information in PMC

References

    1. Andrew M, Paes B, Milner R, Johnston M, Mitchell L, Tollefsen D, et al. Development of the human coagulation system in the healthy premature infant. Blood. (1988) 72:1651–7. 10.1182/blood.V72.5.1651.bloodjournal7251651 - DOI - PubMed
    1. Andrew M, Paes B, Milner R, Johnston M, Mitchell L, Tollefsen D, et al. Development of the human coagulation system in the full-term infant. Blood. (1987) 70:165–72. - PubMed
    1. Andrew M, Vegh P, Johnston M, Bowker J, Ofosu F, Mitchell L. Maturation of the hemostatic system during childhood. Blood. (1992) 80:1998–2005. 10.1182/blood.V80.8.1998.bloodjournal8081998 - DOI - PubMed
    1. Siekmann I, Bjelosevic S, Landman K, Monagle P, Ignjatovic V, Crampin E. Mathematical modelling indicates that lower activity of the haemostatic system in neonates is primarily due to lower prothrombin concentration. Sci Rep. (2019) 9:3936. 10.1038/s41598-019-40435-7 - DOI - PMC - PubMed
    1. Ignjatovic V, Furmedge J, Newall F, Chan A, Berry L, Fong C, et al. Age-related differences in heparin response. Thromb Res. (2006) 118:741–5. 10.1016/j.thromres.2005.11.004 - DOI - PubMed

Publication types

LinkOut - more resources