Use of bivalirudin after initial heparin management among adult patients on long-term venovenous extracorporeal support as a bridge to lung transplant: A case series

IF 2.9 3区医学 Q2 PHARMACOLOGY & PHARMACY

Pharmacotherapy Pub Date : 2024-02-02 DOI:10.1002/phar.2910

Hala Halawi, Jesse E. Harris, Ahmad Goodarzi, Simon Yau, Jihad G. Youssef, Mena Botros, Howard J. Huang

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Abstract

A growing body of evidence supports the use of bivalirudin as an alternative to unfractionated heparin (UFH) for the prevention of thrombotic events in patients on venovenous (VV) extracorporeal membrane oxygenation (ECMO). However, data in patients bridged to lung transplantation are limited. In this case series, we describe the outcomes of six patients who were transitioned from UFH to bivalirudin during their course of VV ECMO support as a bridge to lung transplantation. All six patients were on VV ECMO support until transplant, with a median duration of 73 days. Bivalirudin demonstrated a shorter time to first therapeutic activated thromboplastin time (aPTT) level. Additionally, time in therapeutic range was longer while patients were receiving bivalirudin compared to UFH (median 92.9% vs. 74.6%). However, major bleeding and thrombotic events occurred while patients were receiving either anticoagulant. Based on our experience, bivalirudin appears to be a viable option for anticoagulation in VV ECMO patients bridged to lung transplantation. Larger studies evaluating the optimal anticoagulation strategy in patients bridged to transplant are needed.

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在接受长期静脉体外支持作为肺移植桥梁的成年患者中，在初始肝素管理后使用比伐卢定：病例系列

越来越多的证据支持使用比伐卢定替代非分叶肝素（UFH）来预防静脉（VV）体外膜氧合（ECMO）患者的血栓事件。然而，关于肺移植桥接患者的数据却很有限。在本病例系列中，我们描述了六名患者在作为肺移植桥梁的 VV ECMO 支持过程中从 UFH 过渡到比伐卢定的结果。所有六名患者在移植前均接受了 VV ECMO 支持，中位持续时间为 73 天。比伐卢定可缩短活化凝血活酶时间 (aPTT) 达到首次治疗水平的时间。此外，与 UFH 相比，患者在接受比伐卢定治疗期间进入治疗范围的时间更长（中位 92.9% 对 74.6%）。不过，患者在接受任何一种抗凝剂治疗时都会发生大出血和血栓事件。根据我们的经验，比伐卢定似乎是VV ECMO患者桥接肺移植抗凝治疗的可行选择。我们需要进行更大规模的研究，评估衔接移植患者的最佳抗凝策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pharmacotherapy 医学-药学

CiteScore

7.80

自引率

2.40%

发文量

审稿时长

4-8 weeks

期刊介绍： Pharmacotherapy is devoted to publication of original research articles on all aspects of human pharmacology and review articles on drugs and drug therapy. The Editors and Editorial Board invite original research reports on pharmacokinetic, bioavailability, and drug interaction studies, clinical trials, investigations of specific pharmacological properties of drugs, and related topics.