Bivalirudin and post-cardiotomy ECMO: a word of caution.

Critical Care : the Official Journal of the Critical Care Forum
Marco Ranucci

Abstract

Bivalirudin has been proposed as the sole anticoagulant in patients under extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass. Owing to the pharmacodynamic properties of bivalirudin, areas of blood stagnation should be carefully avoided in order to limit the risk of thrombosis. The ECMO circuit has no reservoir and is usually devoid of blood stagnation areas. Conversely, under some circumstances, intracardiac blood stagnation areas may exist. In this case, there is a potential risk for the spontaneous formation of an intracardiac thrombus. We suggest that, under bivalirudin anticoagulation, a minimal degree of intracardiac blood flow with left heart valve movement is allowed.

References

Apr 28, 2007·The Annals of Thoracic Surgery·Andreas KosterRoland Hetzer
Nov 22, 2011·Critical Care : the Official Journal of the Critical Care Forum·Marco RanucciUNKNOWN Surgical and Clinical Outcome Research Group
Dec 14, 2011·Journal of Cardiothoracic and Vascular Anesthesia·Antonio GrimaldiFederico Pappalardo

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Citations

Aug 12, 2014·BMC Anesthesiology·David B TulmanThomas J Papadimos
Jul 1, 2016·Journal of Intensive Care Medicine·Filippo SanfilippoMarc O Maybauer
Nov 22, 2019·World Journal of Critical Care Medicine·Barry BursteinNathan Smischney
Jan 15, 2016·The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG·Marcia L Buck
Jan 3, 2021·Pediatric Surgery International·Brian P FallonRonald B Hirschl
Oct 10, 2018·ASAIO Journal : a Peer-reviewed Journal of the American Society for Artificial Internal Organs·Troy G SeelhammerYanjun Zhao
Oct 28, 2017·ASAIO Journal : a Peer-reviewed Journal of the American Society for Artificial Internal Organs·Theodore J BereiKatarzyna M Hryniewicz
Aug 27, 2015·ASAIO Journal : a Peer-reviewed Journal of the American Society for Artificial Internal Organs·Megan A Coughlin, Robert H Bartlett
Mar 4, 2021·Journal of Intensive Care Medicine·Janos GeliMarc O Maybauer
May 11, 2021·Indian Journal of Thoracic and Cardiovascular Surgery : Official Organ, Association of Thoracic and Cardiovascular Surgeons of India·Gaurav Kumar, Ashish Maskey
Jul 20, 2021·Critical Care Explorations·Katherine GiulianoGlenn J R Whitman
Aug 2, 2021·Journal of Cardiothoracic and Vascular Anesthesia·Carson WelkerHarish Ramakrishna

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