ArticleThe journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG2025
Evaluation of a Bivalirudin Dosing and Monitoring Protocol in Pediatric Extracorporeal Membrane Oxygenation.
Article in The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Alternate and Emerging Anticoagulation Strategies for Extracorporeal Membrane Oxygenation: A Scoping Review.Journal of clinical medicine · 2026Review
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6 authors.
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Abstract
objectiveBivalirudin is a direct thrombin inhibitor used off-label for systemic anticoagulation in extracorporeal membrane oxygenation (ECMO). There are limited data available in pediatric patients, specifically regarding optimal dosing in this heterogeneous population of patients. This study aimed to characterize bivalirudin use in pediatric patients on ECMO at a single center.
methodsA retrospective chart review was conducted for consecutive patients undergoing ECMO at a quaternary center between January 2021 and June 2023 who received bivalirudin as the primary anticoagulation agent. The primary outcome was the dose of bivalirudin required to achieve activated partial thromboplastin time (aPTT) in the goal range. Additionally, time in therapeutic range, time to initial aPTT goal, dose adjustments required in patients receiving renal replacement therapy, amount of blood and blood products received, incidence of major bleeding, and complete ECMO circuit changes were evaluated.
resultsFourteen patients, including 6 neonates, 5 children, and 3 adolescents, were included in the study. Eleven patients were initially placed on venoarterial ECMO, and 3 were initially placed on venovenous ECMO. The median ECMO duration was 6 days. The median dose of bivalirudin required to achieve the initial goal aPTT level varied between neonates, children, and adolescents (0.1 mg/kg/hr, 0.2 mg/kg/hr, 0.05 mg/kg/hr, respectively).
conclusionsMultiple patient factors including age, indication for ECMO, renal function, and hepatic function must be taken into consideration when determining a starting dose of bivalirudin for these pediatric patients.
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