{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T09:57:20Z","timestamp":1773395840363,"version":"3.50.1"},"reference-count":14,"publisher":"EDP Sciences","issue":"1","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"vor","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Extra Corpor Technol","JECT"],"accepted":{"date-parts":[[2025,8,1]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:p>\n                    <jats:italic>Background<\/jats:italic>\n                    : Although unfractionated heparin (UFH) has traditionally been used for anticoagulation during extracorporeal membrane oxygenation (ECMO), bivalirudin may be preferred due to fewer complications. A prior medication use evaluation of ECMO patients who received bivalirudin resulted in dosing updates for our pharmacist-directed bivalirudin protocol. This study intended to evaluate the efficacy and safety of bivalirudin for anticoagulation during ECMO support post-protocol initiation.\n                    <jats:italic>Methods<\/jats:italic>\n                    : This was a retrospective, single-center, pre-post study. Adult patients requiring ECMO support for at least 24\u00a0h and who received bivalirudin between January 1, 2015 to July 31, 2018 (pre-group) and May 1, 2019 to June 30, 2021 (post-group) were included.\n                    <jats:italic>Results<\/jats:italic>\n                    : There were 38 patients in the pre- and 35 patients in the post-group. The primary outcome, median time to two consecutive activated partial thromboplastin times (aPTTs) within therapeutic range for the initial goal range, was 8.9\u00a0h in the pre- and 14.2\u00a0h in the post-group (\n                    <jats:italic>p<\/jats:italic>\n                    \u00a0=\u00a00.517). In a subgroup analysis of the post-group, the primary outcome was higher in patients with COVID-19 (26.5 vs. 8.6\u00a0h,\n                    <jats:italic>p<\/jats:italic>\n                    \u00a0=\u00a00.018). The median number of dose adjustments to achieve goal aPTT was higher in COVID-19 patients (4 vs. 2,\n                    <jats:italic>p<\/jats:italic>\n                    \u00a0=\u00a00.017).\n                    <jats:italic>Conclusion<\/jats:italic>\n                    : These results suggest that a standardized pharmacist-directed protocol for bivalirudin in ECMO achieves timely therapeutic anticoagulation levels. Patients with COVID-19 trended toward longer times to two consecutive therapeutic aPTTs. Further studies are needed to evaluate dosing strategies in patients with and without COVID-19.\n                  <\/jats:p>","DOI":"10.1051\/ject\/2025045","type":"journal-article","created":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T18:44:36Z","timestamp":1754678676000},"page":"57-64","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of bivalirudin-based anticoagulation for extracorporeal membrane oxygenation, including patients with COVID-19"],"prefix":"10.1051","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-0020-6620","authenticated-orcid":false,"given":"Miranda","family":"Raguindin","sequence":"first","affiliation":[{"name":"Carilion Roanoke Memorial Hospital","place":["USA"]},{"name":"Hartford Hospital","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Casey","family":"Bardsley","sequence":"additional","affiliation":[{"name":"Carilion Roanoke Memorial Hospital","place":["USA"]},{"name":"North Florida Regional Medical Center","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chelsea","family":"Bast","sequence":"additional","affiliation":[{"name":"Carilion Roanoke Memorial Hospital","place":["USA"]},{"name":"Sentara Virginia Beach General Hospital","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Sugrue","sequence":"additional","affiliation":[{"name":"Carilion Roanoke Memorial Hospital","place":["USA"]},{"name":"Duke Raleigh Hospital","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0049-1228","authenticated-orcid":false,"given":"Hasan","family":"Kazmi","sequence":"additional","affiliation":[{"name":"Carilion Roanoke Memorial Hospital","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1188-8602","authenticated-orcid":false,"given":"Ashley","family":"Milkovits","sequence":"additional","affiliation":[{"name":"Carilion Roanoke Memorial Hospital","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"250","published-online":{"date-parts":[[2026,3,13]]},"reference":[{"issue":"3","key":"R1","doi-asserted-by":"crossref","first-page":"410","DOI":"10.5935\/0103-507X.20190063","volume":"31","author":"Chaves","year":"2019","journal-title":"Rev Bras Ter Intensiva"},{"issue":"2","key":"R2","doi-asserted-by":"crossref","first-page":"110","DOI":"10.14797\/mdcj-14-2-110","volume":"14","author":"Ratnani","year":"2018","journal-title":"Methodist Debakey Cardiovasc J"},{"issue":"7","key":"R3","first-page":"E166","volume":"7","author":"Makdisi","year":"2015","journal-title":"J Thorac 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