Factibilidad del uso de bivalirudina como anticoagulante en soporte vital extracorpóreo

Background: Extracorporeal membrane oxygenation (ECMO) is used with increasing frequency in patients with respiratory and cardiac failure. The achievement of an adequate anticoagulation is critical to avoid patient and circuit complications. Aim: To assess the feasibility and safety of anticoagula...

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Autores principales:	Van Sint Jan,Nicolette, Díaz,Rodrigo, Fajardo,Christian, Agliatti,Rocio, Palavecino,Marcela, Hasbún,Pablo, Regueira,Tomás
Lenguaje:	Spanish / Castilian
Publicado:	Sociedad Médica de Santiago 2017
Materias:	Anticoagulants Antithrombins Extracorporeal Membrane Oxygenation Heparin
Acceso en línea:	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000600710
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spelling	oai:scielo:S0034-988720170006007102017-11-17Factibilidad del uso de bivalirudina como anticoagulante en soporte vital extracorpóreoVan Sint Jan,NicoletteDíaz,RodrigoFajardo,ChristianAgliatti,RocioPalavecino,MarcelaHasbún,PabloRegueira,Tomás Anticoagulants Antithrombins Extracorporeal Membrane Oxygenation Heparin Background: Extracorporeal membrane oxygenation (ECMO) is used with increasing frequency in patients with respiratory and cardiac failure. The achievement of an adequate anticoagulation is critical to avoid patient and circuit complications. Aim: To assess the feasibility and safety of anticoagulation with bivalirudin, as an alternative to unfractionated heparin (UFH), in patient with ECMO. Material and Methods: Observational study, which included all patients receiving anticoagulation with bivalirudin during ECMO, according to a standardized protocol, between august 2015 to May 2016. Results: Bivalirudin was used in 13 out 70 patients connected to ECMO. Ten procedures were for cardiac support and three for respiratory support. Mortality was 43%. ECMO lasted 31 ± 31 days. The time of UFH use before changing to bivalirudin was 7 ± 7 days. The reasons to change to bivalirudin were inadequate levels of partial thromboplastin time (PTT) in nine patients, and heparin induced thrombocytopenia (HIT) in four patients. The time of bivalirudin use was 24 ± 33 days. Per patient, a mean of 2.7 ± 4 oxygenators were changed. These had a useful life of 11.4 and 19.1 days during UFH and bivalirudin use, respectively. The mean bivalirudin dose was 0.08 ± 0.04 mg/kg/h. There was no significant bleeding, thrombosis or circuit obstruction during its use. PTT levels (p < 0.01) and platelet count (p < 0.01) increased significantly after the start of bivalirudin use in patients with UHF resistance and HIT, respectively. Conclusions: Bivalirudin was a safe and efficient drug for anticoagulation during ECMO. It is important to have an alternative drug for anticoagulation in ECMO patients.info:eu-repo/semantics/openAccessSociedad Médica de SantiagoRevista médica de Chile v.145 n.6 20172017-06-01text/htmlhttp://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000600710es10.4067/s0034-98872017000600710
institution	Scielo Chile
collection	Scielo Chile
language	Spanish / Castilian
topic	Anticoagulants Antithrombins Extracorporeal Membrane Oxygenation Heparin
spellingShingle	Anticoagulants Antithrombins Extracorporeal Membrane Oxygenation Heparin Van Sint Jan,Nicolette Díaz,Rodrigo Fajardo,Christian Agliatti,Rocio Palavecino,Marcela Hasbún,Pablo Regueira,Tomás Factibilidad del uso de bivalirudina como anticoagulante en soporte vital extracorpóreo
description	Background: Extracorporeal membrane oxygenation (ECMO) is used with increasing frequency in patients with respiratory and cardiac failure. The achievement of an adequate anticoagulation is critical to avoid patient and circuit complications. Aim: To assess the feasibility and safety of anticoagulation with bivalirudin, as an alternative to unfractionated heparin (UFH), in patient with ECMO. Material and Methods: Observational study, which included all patients receiving anticoagulation with bivalirudin during ECMO, according to a standardized protocol, between august 2015 to May 2016. Results: Bivalirudin was used in 13 out 70 patients connected to ECMO. Ten procedures were for cardiac support and three for respiratory support. Mortality was 43%. ECMO lasted 31 ± 31 days. The time of UFH use before changing to bivalirudin was 7 ± 7 days. The reasons to change to bivalirudin were inadequate levels of partial thromboplastin time (PTT) in nine patients, and heparin induced thrombocytopenia (HIT) in four patients. The time of bivalirudin use was 24 ± 33 days. Per patient, a mean of 2.7 ± 4 oxygenators were changed. These had a useful life of 11.4 and 19.1 days during UFH and bivalirudin use, respectively. The mean bivalirudin dose was 0.08 ± 0.04 mg/kg/h. There was no significant bleeding, thrombosis or circuit obstruction during its use. PTT levels (p < 0.01) and platelet count (p < 0.01) increased significantly after the start of bivalirudin use in patients with UHF resistance and HIT, respectively. Conclusions: Bivalirudin was a safe and efficient drug for anticoagulation during ECMO. It is important to have an alternative drug for anticoagulation in ECMO patients.
author	Van Sint Jan,Nicolette Díaz,Rodrigo Fajardo,Christian Agliatti,Rocio Palavecino,Marcela Hasbún,Pablo Regueira,Tomás
author_facet	Van Sint Jan,Nicolette Díaz,Rodrigo Fajardo,Christian Agliatti,Rocio Palavecino,Marcela Hasbún,Pablo Regueira,Tomás
author_sort	Van Sint Jan,Nicolette
title	Factibilidad del uso de bivalirudina como anticoagulante en soporte vital extracorpóreo
title_short	Factibilidad del uso de bivalirudina como anticoagulante en soporte vital extracorpóreo
title_full	Factibilidad del uso de bivalirudina como anticoagulante en soporte vital extracorpóreo
title_fullStr	Factibilidad del uso de bivalirudina como anticoagulante en soporte vital extracorpóreo
title_full_unstemmed	Factibilidad del uso de bivalirudina como anticoagulante en soporte vital extracorpóreo
title_sort	factibilidad del uso de bivalirudina como anticoagulante en soporte vital extracorpóreo
publisher	Sociedad Médica de Santiago
publishDate	2017
url	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000600710
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Factibilidad del uso de bivalirudina como anticoagulante en soporte vital extracorpóreo

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