Issue |
J Extra Corpor Technol
Volume 50, Number 3, September 2018
|
|
---|---|---|
Page(s) | 161 - 166 | |
DOI | https://doi.org/10.1051/ject/201850161 | |
Published online | 15 September 2018 |
Original Articles
Bivalirudin Anticoagulation Dosing Protocol for Extracorporeal Membrane Oxygenation: A Retrospective Review
* Department of Pharmacy; and
† Department of Cardiothoracic Surgery, Parkview Regional Medical Center, Fort Wayne, Indiana
Address correspondence to: Jared Netley, PharmD, Emergency Medicine Pharmacist, Parkview Regional Medical Center, 11109 Parkview Plaza Drive, Fort Waune, IN 46825. E-mail: jared.netley@parkview.com
Received:
4
December
2017
Accepted:
6
April
2018
Anticoagulation with unfractionated heparin during extracorporeal membrane oxygenation (ECMO) is common, but alternative agents are being evaluated for safety and efficacy. The objective of this analysis was to assess if a comprehensive bivalirudin dosing and monitoring protocol effectively guides dose adjustments and monitoring of bivalirudin in patients during ECMO. Our analysis included 11 patients who received bivalirudin during ECMO therapy and had dosing managed using our hospital derived protocol. Patients treated over a 1-year period were included in this retrospective analysis. Clinical characteristics and changes in activated partial thromboplastin time (aPTT) were evaluated from medical records to determine the efficacy of the dosing protocol. ECMO was initiated for acute respiratory distress syndrome in eight (72.7%) patients and for cardiac arrest in three (27.3%) patients. A total of 178 protocol guided dose adjustments were made during the study. Among the dose adjustments, 56 (31.5%) attained the protocol predicted aPTT level change, 96 (53.9%) of the measured aPTT changes were less than predicted, and 26 (14.6%) of the measured aPTT changes were more than predicted. On average, patients were within their defined therapeutic aPTT target range 66.3% of the time. All patients reached their designated aPTT target range within the first 24 hours of therapy. Significant bleeding was documented in eight (72.7%) patients. No clinically evident thromboembolic events were identified in vivo while cannulated. This analysis suggests that bivalirudin can be managed using a dosing protocol to provide anticoagulation therapy to patients during ECMO and can provide foundational guidance for dose adjustment and monitoring for other institutions.
Key words: extracorporeal membrane oxygenation / blood / anticoagulation / bivalirudin / pharmacology
© 2018 AMSECT
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