Non-heparin-based Anticoagulation:

If it is necessary to use an agent other than heparin while on ECMO, the hematology service should be directly involved.

Bivlirudin

  • Bivalirudin is a direct thrombin inhibitor.
  • It can be used as a bolus and infusion similar to how heparin is used.
  • It has a half life of about 25 minutes.
  • Although ACT can be used to measure the effectiveness of bivalirudin, in practice it is harder to titrate.
  • There is no antidote to bivalirudin.

Argatroban

  • Argatroban is another direct thrombin inhibitor.
  • It can be used as a bolus and infusion similar to how heparin is used.
  • The ACT and aPTT are used to measure argatroban's effectiveness.

Next page: Anticoagulation and ECMO: ECMO without anticoagulation

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