Why the study?
Bivalirudin can serve as an alternative anticoagulant in neonates and infants when inaccurate heparin monitoring occurs during mechanical circulatory support.
Can bivalirudin be successfully used for anticoagulation in an infant on ECMO with inaccurate heparin monitoring due to hemolysis and hyperbilirubinemia?
Can bivalirudin be successfully used for anticoagulation in an infant on ECMO with inaccurate heparin monitoring due to hemolysis and hyperbilirubinemia?
Bivalirudin may serve as an effective alternative anticoagulant for infants on ECMO when hemolysis and hyperbilirubinemia preclude accurate heparin monitoring.
Bivalirudin may offer an alternative when heparin monitoring fails in infant ECMO; hypothesis-generating and should not yet change practice.
Heparin has been used for decades as an anticoagulant in patients on mechanical circulatory support, which includes extracorporeal membrane oxygenation (ECMO) and ventricular assist devices. Bivalirudin is a direct thrombin inhibitor that can be used as an alternative anticoagulant in neonates and infants demonstrating inaccurate heparin monitoring. We report a case of a 2-month-old male child who was placed on ECMO for severe acute respiratory distress syndrome. His ECMO course was complicated by severe hemolysis and hyperbilirubinemia, which precluded accurate monitoring of heparin activity. Bivalirudin was successfully used for anticoagulation in this patient.
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Ezetendu et al. (2019) studied this question.
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