Hamzah Mohammed, Seelhammer Troy G, Beshish Asaad G, Byrnes Jonathan, Yabrodi Mouhammad, Szadkowski Adam, Lutfi Riad, Andrijasevic Nicole, Hock Kristal, Worley Sarah, Macrae Duncan J
Department of Pediatric Critical Care, Cleveland Clinic Children's, Cleveland, OH, USA.
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
Thromb Res. 2023 Sep;229:178-186. doi: 10.1016/j.thromres.2023.07.012. Epub 2023 Jul 24.
The objective of this study is to evaluate the outcomes of unfractionated heparin (UFH) compared to bivalirudin anticoagulation in pediatric ExtraCorporeal Membrane Oxygenation (ECMO).
A multicenter retrospective study, that included pediatric patients <18 years of age, who were supported on ECMO between June 2017 and May 2020. Patients treated with UFH were matched 2:1 by age and type of ECMO support to the bivalirudin group.
The bivalirudin group (75 patients) were matched to 150 patients treated with UFH. Baseline characteristics and comorbidities of the two groups were similar. Veno-Arterial ECMO was the most common mode (141/225 [63 %]) followed by extracorporeal cardiopulmonary resuscitation (48/225 [21 %]). Bivalirudin treatment was associated with lower odds of bleeding events (aOR 0.23, 95%CI 0.12-0.45, p < 0.001) and lower odds of thrombotic events (aOR 0.48, 95%CI 0.23-0.98, p = 0.045). Patients who received bivalirudin had lesser odds for transfusion with fresh frozen plasma, and platelets (aOR 0.26, CI 0.12-0.57, p ≤0.001 and aOR 0.28, CI 0.15-0.53, p < 0.001, respectively). After adjusting for the type of ECMO support and adjusting for age, bivalirudin was associated with a decrease in hospital mortality by 50 % compared to the UFH group (aOR 0.50, 95%CI 0.27-0.93, p = 0.028). Similarly, for neurological disability at time of discharge, bivalirudin was associated with higher odds of intact neurological outcomes compared to UFH (OR 1.99 [95%CI 1.13-3.51], p = 0.017).
This study demonstrated that effective anticoagulation can be achieved with bivalirudin, which was associated with lesser odds of bleeding events and utilization of blood products. Bivalirudin, in comparison with UFH, was associated with greater odds of hospital survival and intact neurological function at the time of discharge. A prospective randomized trial is required to validate the results of this study.
本研究的目的是评估普通肝素（UFH）与比伐卢定抗凝在儿科体外膜肺氧合（ECMO）中的效果。
一项多中心回顾性研究，纳入2017年6月至2020年5月期间接受ECMO支持的18岁以下儿科患者。接受UFH治疗的患者按年龄和ECMO支持类型以2:1的比例与比伐卢定组进行匹配。
比伐卢定组（75例患者）与150例接受UFH治疗的患者相匹配。两组的基线特征和合并症相似。静脉-动脉ECMO是最常见的模式（141/225 [63%]），其次是体外心肺复苏（48/225 [21%]）。比伐卢定治疗与出血事件发生率较低相关（调整后比值比[aOR] 0.23，95%置信区间[CI] 0.12 - 0.45，p < 0.001），血栓形成事件发生率也较低（aOR 0.48，95%CI 0.23 - 0.98，p = 0.045）。接受比伐卢定治疗的患者输注新鲜冰冻血浆和血小板的几率较低（分别为aOR 0.26，CI 0.12 - 0.57，p≤0.001和aOR 0.28，CI 0.15 - 0.53，p < 0.001）。在调整ECMO支持类型和年龄后，与UFH组相比，比伐卢定使住院死亡率降低了50%（aOR 0.50，95%CI 0.27 - 0.93，p = 0.028）。同样，对于出院时的神经功能障碍，与UFH相比，比伐卢定与神经功能完好的几率较高相关（比值比[OR] 1.99 [95%CI 1.13 - 3.51]，p = 0.017）。
本研究表明比伐卢定可实现有效的抗凝，且与出血事件和血液制品使用几率较低相关。与UFH相比，比伐卢定与出院时更高的住院生存率和神经功能完好几率相关。需要进行一项前瞻性随机试验来验证本研究的结果。
