Case Report

Bivalirudin Anticoagulation for an Infant with Hyperbilirubinemia and Elevated Plasma-Free Hemoglobin on ECMO

Departments of ^* Pediatric Critical Care, and
^† Nursing, Cleveland Clinic Children’s, Cleveland, Ohio; and
^‡ Cleveland Clinic, Heart and Vascular Institute, Cleveland, Ohio

Address correspondence to: Chidiebere Ezetendu, MD, Department of Pediatric Critical Care, Cleveland Clinic Children’s Hospital, 9500 Euclid Avenue/M-14, Cleveland, OH 44195. E-mail: ezetenc@ccf.org

Received: 3 August 2018
Accepted: 21 November 2018

Abstract

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.