Department of Intensive Care Unit, The First Affiliated Hospital of Xinjiang Medical University, Urumchi, China.
Int J Artif Organs. 2023 Mar;46(3):162-170. doi: 10.1177/03913988221148763. Epub 2023 Jan 4.
There were controversial opinions on the use of bivalirudin versus heparin for anticoagulant therapy in extracorporeal membrane oxygenation. The aim of our present study is to evaluate the efficacy and safety of bivalirudin versus heparin for the maintenance of systemic anticoagulation during adult veno-venous extracorporeal membrane oxygenation (V-V ECMO).
Adult patients who received V-V ECMO support in our center between February 2018and February 2022 were retrospectively recruited. We analyzed their ECMO support time, platelet count, coagulation indicators, blood product infusion volume, the incidence of thrombosis and bleeding, probability of successful weaning of ECMO, and in-hospital mortality.
A total of 58 patients received V-V ECMO support. Thirty-four patients were finally included according to the exclusion and inclusion criteria, 14 and 20 accepted bivalirudin and heparin for anticoagulant therapy, respectively. The Minimum platelet value (98.50 × 10/L (85.50, 123.75) vs 49.50 × 10/L (31.25, 83.00), = 0.002) and mean platelet value (149.90 × 10/L (127.40, 164.80) vs 74.55 × 10/L (62.45, 131.60), = 0.03) and the ratio of successful weaning of ECMO (92.8% vs 60.0%, = 0.033) in bivalirudin group were significantly higher than those in heparin group. The red blood cell infusion volume (7.00 U (3.00, 13.25) vs 13.75 U (7.25, 22.63), = 0.039), platelet infusion volume (0.00 mL (0.00, 75.00) vs 300 mL (0.00, 825.00), = 0.027), and the incidence of major bleeding (0.00% vs 30%, = 0.024) in bivalirudin group were significantly lower than those in heparin group.
In V-V ECMO-supported adult patients, systemic anticoagulation with bivalirudin has achieved the same anticoagulation targets as heparin with less frequency of major bleeding events and lower requirement for blood products without significantly increased risk of thrombosis. Bivalirudin most likely is a safe and effective anticoagulation method for adult patients supported by V-V ECMO.
在体外膜肺氧合（ECMO）中，关于使用比伐卢定与肝素进行抗凝治疗存在争议。本研究旨在评估比伐卢定与肝素在成人静脉-静脉 ECMO（V-V ECMO）中维持全身抗凝的疗效和安全性。
回顾性分析 2018 年 2 月至 2022 年 2 月期间在我院接受 V-V ECMO 支持的成年患者。分析 ECMO 支持时间、血小板计数、凝血指标、血制品输注量、血栓和出血发生率、ECMO 成功撤机率和院内死亡率。
共 58 例患者接受 V-V ECMO 支持。根据排除和纳入标准，最终有 34 例患者符合条件，其中 14 例和 20 例分别接受比伐卢定和肝素抗凝治疗。比伐卢定组的血小板最低值（98.50×10/L（85.50，123.75）比肝素组的 49.50×10/L（31.25，83.00），=0.002）和血小板均值（149.90×10/L（127.40，164.80）比肝素组的 74.55×10/L（62.45，131.60），=0.03）以及 ECMO 成功撤机率（92.8%比肝素组的 60.0%，=0.033）均显著高于肝素组。比伐卢定组红细胞输注量（7.00U（3.00，13.25）比肝素组的 13.75U（7.25，22.63），=0.039）、血小板输注量（0.00mL（0.00，75.00）比肝素组的 300mL（0.00，825.00），=0.027）和大出血发生率（0.00%比肝素组的 30%，=0.024）显著低于肝素组。
在 V-V ECMO 支持的成年患者中，比伐卢定全身抗凝与肝素抗凝达到了相同的抗凝目标，大出血事件发生率更低，血液制品需求更少，血栓形成风险无显著增加。比伐卢定可能是 V-V ECMO 支持的成年患者安全有效的抗凝方法。
