TABLE 1.
Selected Direct Thrombin Inhibitor Studies
| Reference | Year | Patient Population (n) | Study Design | Findings |
|---|---|---|---|---|
| Moffett and Teruya (19) | 2014 | Pediatrics (Pediatric Health Information System registry) | Administrative database review to determine frequency of use for each DTI | Argatroban 70%, bivalirudin 23%, lepirudin 7% |
| Nagle et al (18) | 2013 | Pediatrics (12) | Case series-ECMO using DTI for HIT, heparin resistance, or thrombosis | -41.7% survival -High interpatient dose variability: 0.045–0.48 mg/kg/hr, and increased dose requirement over time -Eight required circuit change. |
| Ranucci et al (23) | 2011 | Adults/pediatrics (21) | Retrospective comparison of eight patients requiring postcardiotomy ECMO treated with heparin and 13 treated with bivalirudin | -Bivalirudin group had longer aPTT, activated clotting time, and lower blood loss -Heparin group received more platelet, plasma, and antithrombin -Five children in each group with one surviving in each |
| Pieri et al (24) | 2013 | Adults (20) | Retrospective cohort of 10 patients receiving bivalirudin on ECMO vs 10 heparin controls | -aPTT variability (>20% compared with previous sample) higher in heparin group -No difference in bleeding, thromboembolic events, or mortality |
| Menk et al (25) | 2017 | Adults (39) | Case-control study (39 patients with acute respiratory distress syndrome on ECMO receiving argatroban vs 39 matched patients receiving heparin) | -No significant differences in major and minor bleeding complications, thromboembolic events, rates of transfusion, and device-associated complications -Over time on ECMO, there were significantly fewer aPTT values below the targeted aPTT goal in the argatroban group vs the heparin group (p < 0.05) |
| Beiderlinden et al (26) | 2007 | Adults (9) | Case series of patients receiving argatroban for suspected HIT | -At argatroban infusion rates of 0.2 g/kg/min, aPTT, and thrombin times reached targeted levels -No oxygenator or extracorporeal system clotting was observed over an average duration of argatroban infusion of 4 d |
aPTT = activated partial thromboplastin time, DTI = direct thrombin inhibitors, ECMO = extracorporeal membrane oxygenation, HIT = heparin-induced thrombocytopenia.