ABSTRACT
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) induces hemostatic alterations that may contribute to hematological complications. Unfractionated heparin (UFH) is the mainstay antithrombotic in ECMO and depends on antithrombin III (AT III) to exhibit its actions. However, it bears the risk for heparin-induced thrombocytopenia. Bivalirudin is a direct thrombin inhibitor and is inherently not dependent on AT III. AIM OF THE STUDY: To assess the efficacy and safety profiles of UFH compared with bivalirudin during ECMO support. METHODS: We retrospectively reviewed 52 adult patients who were supported by ECMO from 1 January 2013 to 1 September 2018. Among them, 33 received UFH and 19 received bivalirudin. We analyzed their 7-day rate of composite thrombotic, bleeding, and mortality episodes while on anticoagulation. RESULTS: There were no statistical differences in the 7-day rate of composite thrombosis (33.3% vs 26.3%; P = 0.60), major bleeding (18.2% vs 5.3%; P = .24), 30-day mortality, (42.4% vs 26.3%; P = .37), or in-hospital mortality (45.5% vs 36.8%; P = .58). The percentage of time activated partial thromboplastin time (aPTT) was within the therapeutic range was higher with bivalirudin (50% vs 85.7%; P = .007). CONCLUSIONS: This study suggests that UFH and bivalirudin are associated with similar rates of thrombosis, major bleeding, and mortality events in patients supported by ECMO. However, it was observed that bivalirudin consistently maintained aPTT within the therapeutic range in comparison to UFH.
Subject(s)
Anticoagulants/administration & dosage , Extracorporeal Membrane Oxygenation/adverse effects , Heparin/administration & dosage , Hirudins/administration & dosage , Peptide Fragments/administration & dosage , Thrombosis/etiology , Thrombosis/prevention & control , Adolescent , Adult , Aged , Aged, 80 and over , Anticoagulants/adverse effects , Female , Heparin/adverse effects , Hirudins/adverse effects , Humans , Male , Middle Aged , Peptide Fragments/adverse effects , Recombinant Proteins/administration & dosage , Recombinant Proteins/adverse effects , Retrospective Studies , Thrombocytopenia/chemically induced , Young AdultABSTRACT
INTRODUCTION: The purpose of this study was to evaluate safety and efficacy of intensified antiplatelet therapy guided by VerifyNow assay P2Y12 reaction unit (PRU) reported values in patients undergoing neuroendovascular procedures. METHODS: An observational, retrospective review was conducted at a single academic tertiary referral center and comprehensive stroke center from December 1, 2012, to August 31, 2014. The primary objective was to determine the prevalence of thromboembolic complications stratified by preprocedural PRU values. Secondary outcomes were assessed by investigating whether the goal PRU value of 190 or less is sufficient to reduce thromboembolic complications on the day of the procedure, and 30- and 90-day postprocedure. RESULTS: There was no statistically significant difference in the overall rate of complications in the two groups (two events in the group with preprocedural PRU values of 190 or more versus seven events in the group with preprocedural PRU values of less than 190, p = 0.668). Furthermore, the rates of thromboembolic events by 90 days were not significantly different in the two groups (one event in the group with preprocedural PRU ≥ 190 versus four events in patients with preprocedural PRU < 190, p = 1). Similarly, there was no statistically significant difference in the rate of hemorrhagic events in the two groups by 90-day postprocedure (one versus three events, p = 0.558). CONCLUSION: The observed rate of thromboembolic and hemorrhagic complications in patients with preprocedural PRU values of less than 190 was not significantly different from the rate observed in patients with preprocedural PRU values of greater than 190. Sources of funding: No external funding used.
