Anticoagulation for critically ill cardiac surgery patients: is primary bivalirudin the next step?

@article{Pappalardo2014AnticoagulationFC,
  title={Anticoagulation for critically ill cardiac surgery patients: is primary bivalirudin the next step?},
  author={Federico Pappalardo and Nataliya Agracheva and Remo Daniel Covello and Marina Pieri and Michele De Bonis and Maria Grazia Calabr{\'o} and Andreas Koster and Alberto Zangrillo},
  journal={Journal of cardiothoracic and vascular anesthesia},
  year={2014},
  volume={28 4},
  pages={
          1013-17
        }
}
OBJECTIVE Anticoagulation with unfractionated heparin (UFH) in critically ill cardiac surgery patients has several limitations, including the risk of heparin-induced thrombocytopenia. The use of a direct thrombin inhibitor, such as bivalirudin, might either treat this complication or completely eliminate it. The aim of the present study was to analyze the use of bivalirudin in this setting, as either a secondary drug switching from heparin or as the primary anticoagulant, and to evaluate… 
View on PubMed
icaa.ir
13 Citations
Background Citations
4
Methods Citations
1

13 Citations

Citation Type

Citation Type

Presentation, management and outcome of heparin-induced thrombocytopenia after valvular heart surgery.
TLDR
Conservative management with early diagnosis and substitutive anticoagulation therapy introduction was associated with a low rate of clinical events and a remarkably good outcome with aLow mortality rate in this contemporary series of patients.
European guidelines on perioperative venous thromboembolism prophylaxis: Intensive care.
TLDR
An institution-wide protocol for the prevention of venous thromboembolism is recommended and the use of pharmacological prophylaxis in critically ill patients with severe liver dysfunction should be carefully balanced against the risk of bleeding.
Comparison of Anticoagulation Strategies in Patients Requiring Venovenous Extracorporeal Membrane Oxygenation: Heparin Versus Bivalirudin*
TLDR
Patients receiving bivalirudin for systemic anticoagulation on venovenous extracorporeal membrane oxygenation experienced a decrease in the number of extracORM oxygenation circuit-related thrombotic events as well as a significant decrease in volume of blood products administered.
Impact of CytoSorb on kinetics of vancomycin and bivalirudin in critically ill patients.
TLDR
Preliminary data support the use of CytoSorb as adjunct therapy in critically ill patients and suggest it is effective in mitigating the systemic inflammatory response and safe with respect to vancomycin and bivalirudin administration.
Thromboprophylaxis in Extracorporeal Circuits: Current Pharmacological Strategies and Future Directions
TLDR
A concise overview of the primary and alternate agents and monitoring used for thromboprophylaxis during use of ECLS is provided and the potential for further biomaterial and technologic developments and what they could provide when applied in the clinical arena is explored.
Eleven Years of Venovenous Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome: From H1N1 to SARS-CoV-2. Experience and Perspectives of a National Referral Center
TLDR
V ECMO is the pivotal rescue treatment for refractory ARDS—timely treatment and optimal care are needed to optimize therapy, as duration of support is associated with outcome.
Epidemiology of Stroke in Pediatric Cardiac Surgical Patients Supported With Extracorporeal Membrane Oxygenation.
Eleven years of VV ECMO for ARDS: from H1N1 to SARS-COV-2. Experience and perspectives of a national referral center
TLDR
V ECMO is the pivotal rescue treatment for refractory ARDS: timely treatment and optimal care are needed to optimize therapy, since duration of support is associated with outcome.
Influence of Body Mass Index on the Activated Clotting Time Under Weight‐Based Heparin Dose
TLDR
This investigation was to explore the influence of body mass index (BMI) on ACT in patients received weight‐based dose of UFH during PCI treatment to reduce the incidence of thrombotic adverse events and hemorrhagic complications.
Do we need heparin coating for extracorporeal membrane oxygenation? New concepts and controversial positions about coating surfaces of extracorporeal circuits.
TLDR
Data in the literature show that heparin-induced thrombocytopenia is a major issue in the extracorporeal membrane oxygenation scenario, and no relevant benefits have been shown comparing heparIn and no-heparin coating.
...
1
2
...

References

SHOWING 1-10 OF 30 REFERENCES
Bivalirudin utilization in cardiac surgery: shifting anticoagulation from indirect to direct thrombin inhibition
TLDR
Bivalirudin can be used in this setting in Canada as an anticoagulant in patients with heparin-induced thrombocytopenia provided the cardiac anesthesiologist is knowledgeable about potential complications from its use and knows how to manage or mitigate their incidence appropriately.
Bivalirudin versus heparin as an anticoagulant during extracorporeal membrane oxygenation: a case-control study.
TLDR
Bivalirudin-based antICOagulation may represent a new method of anticoagulation for reducing thromboembolic and bleeding complications, which still jeopardize the application of extracorporeal membrane oxygenation.
Update in hematology: heparin-induced thrombocytopenia and bivalirudin.
  • J. Augoustides
  • Medicine, Biology
    Journal of cardiothoracic and vascular anesthesia
  • 2011
TLDR
Bivalirudin is an established alternative to heparin as a thrombin inhibitor for cardiac surgery and it is likely that future trials will investigate which anticoagulant confers better outcomes after cardiac surgery, as is the case in percutaneous coronary intervention.
Validation of long-term benefits of bivalirudin versus unfractionated heparin in routine clinical practice after percutaneous coronary intervention.
Argatroban anticoagulation for heparin induced thrombocytopenia in patients with ventricular assist devices.
TLDR
Argatroban anticoagulation is feasible in patients with HIT after VAD implantation, without increasing bleeding risk, as compared to historical controls of patients treated with lepirudin in the period 2000-2005.
Bivalirudin-based versus conventional heparin anticoagulation for postcardiotomy extracorporeal membrane oxygenation
TLDR
Bivalirudin as the sole anticoagulant can be safely used for postcardiotomy ECMO, with a better coagulation profile, less bleeding, and allogeneic transfusions, and costs are reduced in bivalirUDin-treated patients.
Comparison of safety and efficacy of bivalirudin versus unfractionated heparin in high-risk patients undergoing percutaneous coronary intervention (from the Anti-Thrombotic Strategy for Reduction of Myocardial Damage During Angioplasty-Bivalirudin vs Heparin study).
Perioperative thrombocytopenia in cardiac surgical patients - incidence of heparin-induced thrombocytopenia, morbidities and mortality.
  • M. Thielmann, M. Bunschkowski, +5 authors P. Massoudy
  • Medicine, Biology
    European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
  • 2010
Heparin-induced thrombocytopenia following cardiac surgery is associated with poor outcome.
TLDR
HIT was associated with perioperative platelet transfusions and carried a remarkably high risk of thromboembolic complications and death, and early recognition of heparin-associated antiplatelet antibodies and alternative anticoagulation strategies need to be implemented.
Evaluation and management of thrombocytopenia and suspected heparin-induced thrombocytopenia in hospitalized patients: The Complications After Thrombocytopenia Caused by Heparin (CATCH) registry.
...
1
2
3
...