J Extra Corpor Technol
Department of Pharmacy Practice, Nova Southeastern University, 3300 S University Dr, Fort Lauderdale, FL 33328, United States.
Published: September 2023
Background: Hospitalized COVID-19 patients with hypoxemic respiratory failure may deteriorate despite invasive mechanical ventilation and thus require extracorporeal membrane oxygenation (ECMO) support. Unfractionated heparin (UFH) is the antithrombotic of choice, however, bivalirudin may offer more predictable pharmacokinetics resulting in consistent anticoagulant effects with lower bleeding and thrombotic occurrences. The aim of this study was to evaluate efficacy and safety outcomes in patients undergoing venovenous (VV) ECMO receiving bivalirudin or UFH-based anticoagulation.
Methods: This retrospective, single-center, observational cohort study included patients with confirmed COVID-19 infection requiring VV ECMO support receiving anticoagulation with UFH or bivalirudin. Primary endpoints were time to reach therapeutic aPTT, percent time spent in aPTT range, and the occurrence of thrombotic events over the entire course of ECMO support. Secondary endpoints included the incidence of major/minor bleeding, the ability to wean off ECMO support, in-hospital mortality, and length of stay.
Results: Twenty-two patients were included in the study (n = 10 UFH, n = 12 bivalirudin). Time to therapeutic aPTT was achieved faster with UFH (10 h vs. 20 h). The percentage time spent within the goal aPTT range was similar between UFH and bivalirudin (50% vs. 52%). Thrombotic events were significantly higher in the UFH group (40% DVT, 40% PE, 80% oxygenator thrombus in ECMO machine, 10% ischemic stroke) versus bivalirudin (8% DVT, 17% PE, 33% oxygenator thrombus, no ischemic strokes) (CI 95%, p = 0.04). The overall bleeding incidence was higher in the UFH arm (90% vs. 75%). The mortality rate was 90% in the UFH group and 58% in the bivalirudin group. The length of stay was similar between the two study arms.
Conclusion: In hospitalized patients with COVID-19-associated acute respiratory distress syndrome (ARDS) on VV ECMO support, the use of bivalirudin showed to be a viable anticoagulation alternative in terms of efficacy compared to UFH and resulted in a favorable safety profile with lower rates of bleeding and thrombotic events.
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http://dx.doi.org/10.1051/ject/2023027 | DOI Listing |
J R Stat Soc Ser A Stat Soc
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Biostatistics, University of Michigan, 1415 Washington Heights, Michigan 48109, USA.
Model integration refers to the process of incorporating a fitted historical model into the estimation of a current study to increase statistical efficiency. Integration can be challenging when the current model includes new covariates, leading to potential model misspecification. We present and evaluate seven existing and novel model integration techniques, which employ both likelihood constraints and Bayesian informative priors.
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Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seúl, República de Corea. Department of Digital Health, SAIHST, Sungkyunkwan University, Seúl, República de Corea.
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J Soc Cardiovasc Angiogr Interv
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Division of Cardiovascular Disease, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Korean Circ J
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Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Background And Objectives: Data are limited on the clinical manifestations and outcomes of acute myocarditis from a large-scale registry. We investigated acute myocarditis's clinical characteristics and prognosis from a large-scale, multi-center registry in the Republic of Korea.
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PLoS One
January 2025
Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, United States of America.
Introduction: Respiratory syncytial virus (RSV) is the leading cause of hospitalization among US infants. Characterizing service utilization during infant RSV hospitalizations may provide important information for prioritizing resources and interventions.
Objective: The objective of this study was to describe the procedures and services received by infants hospitalized during their first RSV episode in their first RSV season, in addition to what proportion of infants died during this hospitalization.
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