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Factibilidad del uso de bivalirudina como anticoagulante en soporte vital extracorpóreo / Experience with anticoagulation with bivalirudin during extracorporeal membrane oxygenation
Van Sint Jan, Nicolette; Díaz, Rodrigo; Fajardo, Christian; Agliatti, Rocio; Palavecino, Marcela; Hasbún, Pablo; Regueira, Tomás.
Affiliation
  • Van Sint Jan, Nicolette; Clínica las Condes. Centro de Pacientes Críticos. Santiago. CL
  • Díaz, Rodrigo; Clínica las Condes. Centro de Pacientes Críticos. Santiago. CL
  • Fajardo, Christian; Clínica las Condes. Centro de Pacientes Críticos. Santiago. CL
  • Agliatti, Rocio; Clínica las Condes. Centro de Pacientes Críticos. Santiago. CL
  • Palavecino, Marcela; Clínica las Condes. Centro de Pacientes Críticos. Santiago. CL
  • Hasbún, Pablo; Clínica las Condes. Centro de Pacientes Críticos. Santiago. CL
  • Regueira, Tomás; Clínica las Condes. Centro de Pacientes Críticos. Santiago. CL
Rev. méd. Chile ; 145(6): 710-715, June 2017. tab, graf
Article in Es | LILACS | ID: biblio-902535
Responsible library: CL1.1
RESUMEN

Background:

Extracorporeal membrane oxygenation (ECMO) is used with increasing frequency in patients with respiratory and cardiac failure. The achievement of an adequate anticoagulation is critical to avoid patient and circuit complications.

Aim:

To assess the feasibility and safety of anticoagulation with bivalirudin, as an alternative to unfractionated heparin (UFH), in patient with ECMO. Material and

Methods:

Observational study, which included all patients receiving anticoagulation with bivalirudin during ECMO, according to a standardized protocol, between august 2015 to May 2016.

Results:

Bivalirudin was used in 13 out 70 patients connected to ECMO. Ten procedures were for cardiac support and three for respiratory support. Mortality was 43%. ECMO lasted 31 ± 31 days. The time of UFH use before changing to bivalirudin was 7 ± 7 days. The reasons to change to bivalirudin were inadequate levels of partial thromboplastin time (PTT) in nine patients, and heparin induced thrombocytopenia (HIT) in four patients. The time of bivalirudin use was 24 ± 33 days. Per patient, a mean of 2.7 ± 4 oxygenators were changed. These had a useful life of 11.4 and 19.1 days during UFH and bivalirudin use, respectively. The mean bivalirudin dose was 0.08 ± 0.04 mg/kg/h. There was no significant bleeding, thrombosis or circuit obstruction during its use. PTT levels (p < 0.01) and platelet count (p < 0.01) increased significantly after the start of bivalirudin use in patients with UHF resistance and HIT, respectively.

Conclusions:

Bivalirudin was a safe and efficient drug for anticoagulation during ECMO. It is important to have an alternative drug for anticoagulation in ECMO patients.
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Full text: 1 Index: LILACS Main subject: Peptide Fragments / Extracorporeal Membrane Oxygenation / Hirudins / Anticoagulants Type of study: Observational_studies Limits: Adolescent / Adult / Child / Female / Humans / Male Language: Es Journal: Rev. méd. Chile Journal subject: MEDICINA Year: 2017 Type: Article

Full text: 1 Index: LILACS Main subject: Peptide Fragments / Extracorporeal Membrane Oxygenation / Hirudins / Anticoagulants Type of study: Observational_studies Limits: Adolescent / Adult / Child / Female / Humans / Male Language: Es Journal: Rev. méd. Chile Journal subject: MEDICINA Year: 2017 Type: Article