Factibilidad del uso de bivalirudinacomo anticoagulante en soporte vitalextracorpóreo

Junio 2017

ARTÍCULO DE INVESTIGACIÓN 710 Rev Med Chile 2017; 145: 710-715 Factibilidad del uso de bivalirudina como anticoagulante en soporte vital extracorpóreo Nicolette Van Sint Jan1, Rodrigo DÍaz2, Christian Fajardo2, Rocio Agliatti2, Marcela Palavecino1, Pablo Hasbún1, Tomás Regueira1 Experience with anticoagulation with bivalirudin during extracorporeal membrane oxygenation 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. (Rev Med Chile 2017; 145: 710-715) Key words: Anticoagulants; Antithrombins; Extracorporeal Membrane Oxygenation; Heparin. 1Centro de Pacientes Críticos, Clínica las Condes. Santiago, Chile. 2Unidad ECMO, Departamento de Anestesia, Clínica las Condes. Santiago, Chile. Los autores no declaran conflicto de intereses. El trabajo no contó con apoyo financiero. Recibido el 30 de diciembre de 2016, aceptado el 12 de junio de 2017. Correspondencia a: Dr. Tomás Regueira Estoril 450, Las Condes. tregueira@clinicalascondes.cl El soporte vital extracorpóreo (ECMO, del inglés extracorporeal membrane oxigenation) es utilizado cada vez con mayor frecuencia y éxito, tanto en patologías respiratoria como cardíaca1,2. Los criterios de ingreso son cada vez más flexibles en términos de gravedad y condición de base de los pacientes, lo que se asocia a procesos de soporte de cada vez mayor duración. Lograr una anticoagulación efectiva es fundamental durante el tiempo en ECMO. Una anticoagulación inefectiva se asocia a embolias sistémicas, hemorragia, pérdidas de volumen progresivas o agudas del circuito y alteraciones de la membrana de oxigenación, todas estas complicaciones se asocian a riesgo de muerte. La droga más comúnmente usada para lograr


Junio 2017
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