University of Florida Health Shands Children's Hospital, Gainesville, FL, USA.
University of Florida College of Pharmacy, Gainesville, FL, USA.
Ann Pharmacother. 2021 Jan;55(1):59-64. doi: 10.1177/1060028020937819. Epub 2020 Jun 26.
Although heparin has previously been the anticoagulant of choice during mechanical circulatory support (MCS), there is a lack of consistency in dose-response in pediatric patients. Bivalirudin offers more consistent dose-response in adults; however, there are limited data for pediatrics use.
The purpose was to characterize the usage, dosage, and safety profile of bivalirudin when used for pediatric MCS in a tertiary care pediatric hospital.
A retrospective review of pediatric patients receiving bivalirudin for extracorporeal membrane oxygenation/ventricular assist device (ECMO/VAD) anticoagulation was conducted. The primary outcome was the average dose of bivalirudin. Additional outcomes included initial and maximum bivalirudin dose, time to first therapeutic activated partial thromboplastin time (aPTT), time within goal aPTT range, bleeding and clotting complications, and cost. Data were compared between ECMO and VAD patients.
Thirty-four patients were included. The median dose of bivalirudin was 0.37 mg/kg/h (interquartile range [IQR] = 0.21-0.56), with a maximum dose of 0.62 mg/kg/h (IQR = 0.33-0.91). VAD patients had a higher median and maximum dose as compared with ECMO patients. Patients achieved their therapeutic goal in a median of 6.1 hours and averaged 61.9% time within therapeutic aPTT. One patient had significant hemorrhage, whereas 3 patients had clotting requiring a circuit change. Bivalirudin acquisition cost was higher than heparin.
Bivalirudin dosing in ECMO and VAD patients is consistent with dosing seen in previous reports but may be higher in VAD patients. Comparative studies between heparin and bivalirudin are necessary to compare cost-effective outcomes for pediatric patients.
虽然肝素在机械循环支持（MCS）期间一直是抗凝的首选，但在儿科患者中，剂量反应缺乏一致性。比伐卢定在成人中提供更一致的剂量反应；然而，儿科使用的数据有限。
本研究旨在描述在一家三级儿科医院使用比伐卢定治疗儿科 MCS 的使用情况、剂量和安全性概况。
对接受比伐卢定进行体外膜氧合/心室辅助装置（ECMO/VAD）抗凝的儿科患者进行回顾性研究。主要结局是比伐卢定的平均剂量。其他结局包括比伐卢定的初始和最大剂量、首次治疗性激活部分凝血活酶时间（aPTT）的时间、目标 aPTT 范围内的时间、出血和凝血并发症以及成本。比较 ECMO 和 VAD 患者的数据。
共纳入 34 例患者。比伐卢定的中位剂量为 0.37mg/kg/h（四分位距 [IQR] = 0.21-0.56），最大剂量为 0.62mg/kg/h（IQR = 0.33-0.91）。与 ECMO 患者相比，VAD 患者的中位和最大剂量更高。患者中位时间 6.1 小时达到治疗目标，平均有 61.9%的时间在治疗性 aPTT 范围内。1 例患者出现明显出血，3 例患者出现需要更换回路的凝血。比伐卢定的获取成本高于肝素。
ECMO 和 VAD 患者的比伐卢定剂量与以前的报告中所见剂量一致，但 VAD 患者的剂量可能更高。需要对肝素和比伐卢定进行比较研究，以比较儿科患者的成本效益结果。
