The Changing Landscape of Anticoagulation in Pediatric Extracorporeal Membrane Oxygenation: Use of the Direct Thrombin Inhibitors

Cindy Neunert; Meera Chitlur; Cornelia Heleen van Ommen

doi:10.3389/fmed.2022.887199

The Changing Landscape of Anticoagulation in Pediatric Extracorporeal Membrane Oxygenation: Use of the Direct Thrombin Inhibitors

Front Med (Lausanne). 2022 Jul 6:9:887199. doi: 10.3389/fmed.2022.887199. eCollection 2022.

Authors

Cindy Neunert¹, Meera Chitlur², Cornelia Heleen van Ommen³

Affiliations

¹ Department of Pediatrics, Columbia University Medical Center, New York, NY, United States.
² Division of Hematology, Oncology, Carmen and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, United States.
³ Department of Pediatric Hematology and Oncology, Erasmus Medical Center University Medical Center Sophia Children's Hospital, Rotterdam, Netherlands.

Abstract

Bleeding and thrombosis frequently occur in pediatric patients with extracorporeal membrane oxygenation (ECMO) therapy. Until now, most patients are anticoagulated with unfractionated heparin (UFH). However, heparin has many disadvantages, such as binding to other plasma proteins and endothelial cells in addition to antithrombin, causing an unpredictable response, challenging monitoring, development of heparin resistance, and risk of heparin-induced thrombocytopenia (HIT). Direct thrombin inhibitors (DTIs), such as bivalirudin and argatroban, might be a good alternative. This review will discuss the use of both UFH and DTIs in pediatric patients with ECMO therapy.

Keywords: anticoagulation; argatroban; bivalirudin; extracorporeal membrane oxygenation; pediatric; unfractionated heparin.

Publication types

Review