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Monitoring bivalirudin therapy in children on extracorporeal circulatory support devices: Thromboelastometry versus

Jun Teruya1, Lisa Hensch2, Karen Bruzdoski2

  • 1Department of Pathology & Immunology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States of America; Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States of America; Department of Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States of America.

Thrombosis Research
|December 30, 2019
PubMed

Insights

Thromboelastometry (ROTEM) assays, specifically HEPTEM and INTEM, show promise in monitoring bivalirudin anticoagulation in pediatric extracorporeal life support (ECLS) patients. These methods correlate well with traditional tests and may offer a superior alternative for managing heparin-like effects.

Area of Science:

  • Pediatric Critical Care Medicine
  • Hematology
  • Cardiovascular Surgery

Background:

  • Bivalirudin is a key anticoagulant for pediatric extracorporeal life support (ECLS).
  • Activated partial thromboplastin time (aPTT) is the standard monitoring test, but its utility with thromboelastometry (ROTEM) in ECLS is not well-established.
  • ROTEM offers a comprehensive assessment of hemostasis.

Purpose of the Study:

  • To evaluate the effectiveness of ROTEM assays in monitoring bivalirudin therapy in pediatric patients on ECMO or VAD.
  • To compare ROTEM results with standard coagulation assays for bivalirudin monitoring.

Main Methods:

  • Retrospective analysis of 106 blood samples from 18 pediatric patients on ECMO/VAD receiving bivalirudin.
  • Comparison of ROTEM (EXTEM, INTEM, HEPTEM, FIBTEM) with routine tests (aPTT, HPTT, PT, fibrinogen, platelet count).
  • Analysis of clotting time (CT) and maximum clot firmness (MCF) in ROTEM assays.

Main Results:

  • Strong correlation observed between HPTT and HEPTEM CT; moderate correlation between aPTT and INTEM CT.
  • Bivalirudin dose showed age-dependence, not correlation with specific tests.
  • FIBTEM MCF correlated well with fibrinogen, but overestimated levels at high platelet counts.
  • Heparin-like effect detected in 39% of samples.

Conclusions:

  • INTEM and HEPTEM CT prolongation correlate with aPTT and HPTT, suggesting ROTEM as a viable alternative for bivalirudin monitoring.
  • HPTT and HEPTEM CT are potentially preferable for ECLS due to better detection of heparin-like effects.
  • ROTEM provides valuable insights into hemostasis during bivalirudin therapy in pediatric ECLS.
Abstract

Keywords:
BivalirudinECMOHeparin-like substanceMonitoringROTEMVAD

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