{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T09:51:54Z","timestamp":1791366714910,"version":"4.3.1"},"reference-count":28,"publisher":"Georg Thieme Verlag KG","issue":"07","funder":[{"name":"Mitsubishi Pharma"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thorac Cardiovasc Surg"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:p>ECMO patients can develop heparin (Hep)-induced thrombocytopenia type II (HIT II). Approval for direct thrombin antagonism is lacking. We analyze if direct thrombin antagonism (DTA) is feasible, safe, and not inferior to heparin.<\/jats:p>\n                  <jats:p>A total of 254 multicenter prospective patients (vv- or va-ECMO) were analyzed in four different cardiothoracic, pulmonary, or anesthesiological intensive care units at university hospitals in Giessen and Frankfurt from 2020 to 2022.<\/jats:p>\n                  <jats:p>Heparin was always received by 153 va-ECMO\/101 vv-ECMO patients (95\/43), only DTA (8\/6) or a switch (50\/52) from heparin to DTA in cases of suspected HITII and reduced platelet count (reduction: p\u2009=\u20090.017). ICU morbidity, survival, therapeutic stability of anticoagulation, bleeding, thrombosis, and technical integrity were analyzed regarding noninferiority and superiority of DTA versus heparin. Patients who changed anticoagulation showed increased infection levels before the change. Before switching from heparin to DTA, there was only a moderate increase in the INR, a decrease in the Quick, and no therapeutic increase in the PTT with heparin. With regard to thrombosis and system occlusions, there is no difference between heparin and DTA. Weaning rates from extracorporeal support and survival analysis did show noninferiority of DTA. After switching, a clear superiority of DTA in terms of (A) overall complication rate CI((0.6479\/0.7871\/0.9546)) (defined as bleeding from any cause, stroke, amputation, thrombosis and device-occlusion) and (B) bleeding from any cause alone CI((0.6432\/0.7829\/0.9513)) and a noninferiority in terms of preventing strokes exists.<\/jats:p>\n                  <jats:p>DTA is not inferior to heparin in ECLS\/ECMO therapy. Regarding all complications, stroke, thromboembolism, and amputation DTA is superior.<\/jats:p>","DOI":"10.1055\/a-2851-6221","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T22:52:56Z","timestamp":1777330376000},"page":"577-587","source":"Crossref","is-referenced-by-count":0,"title":["Risk Reduction by Direct Thrombin Antagonism During ECMO Therapy"],"prefix":"10.1055","volume":"74","clinical-trial-number":[{"clinical-trial-number":"drks00011416","registry":"10.18810\/drks"}],"author":[{"given":"Susanne","family":"Rohrbach","sequence":"first","affiliation":[{"name":"Institute of Physiology, Justus-Liebig-Universitat Giessen, Giessen, Hessen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurice","family":"Himmel","sequence":"first","affiliation":[{"name":"Department for Adult and Pediatric Cardiac and Vascular Surgery, University Hospital Giessen and Marburg, Giessen, Hessen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joern","family":"Pons-Kuehnemann","sequence":"first","affiliation":[{"name":"Institute for Medical Informatics and Statistics, University Hospital Giessen, Giessen, Hessen, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4431-7002","authenticated-orcid":false,"given":"Bernd","family":"Niemann","sequence":"first","affiliation":[{"name":"Department of Cardiac-, Thoracic and Vascular Surgery, University Medical Center G\u00f6ttingen, G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Spaenig","sequence":"additional","affiliation":[{"name":"Department for Adult and Pediatric Cardiac and Vascular Surgery, University Hospital Giessen and Marburg, Giessen, Hessen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"B\u00f6ning","sequence":"additional","affiliation":[{"name":"Department for Adult and Pediatric Cardiac and Vascular Surgery, University Hospital Giessen and Marburg, Giessen, Hessen, Germany"},{"name":"Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Brenck","sequence":"additional","affiliation":[{"name":"Department for Anesthesiology and Intensive Care Medicine, University Hospital Giessen and Marburg, Giessen, Hessen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Sander","sequence":"additional","affiliation":[{"name":"Department for Anesthesiology and Intensive Care Medicine, University Hospital Giessen and Marburg, Giessen, Hessen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Walther","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Hospital Frankfurt, Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1056\/NEJMcp1411910","article-title":"Clinical Practice. Heparin-induced thrombocytopenia","volume":"373","author":"A Greinacher","year":"2015","journal-title":"N Engl J Med"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1007\/s00134-020-06031-4","article-title":"Platelets and extra-corporeal membrane oxygenation in adult patients: a systematic review and meta-analysis","volume":"46","author":"F Jiritano","year":"2020","journal-title":"Intensive Care Med"},{"issue":"21","key":"ref3","doi-asserted-by":"crossref","first-page":"2519","DOI":"10.1016\/j.jacc.2016.02.073","article-title":"Heparin-induced thrombocytopenia: a comprehensive clinical review","volume":"67","author":"B S Salter","year":"2016","journal-title":"J Am Coll Cardiol"},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"e495S","DOI":"10.1378\/chest.11-2303","article-title":"Treatment and prevention of heparin-induced thrombocytopenia: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines","volume":"141","author":"L A Linkins","year":"2012","journal-title":"Chest"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.thromres.2021.12.024","article-title":"Is bivalirudin an alternative anticoagulant for extracorporeal membrane oxygenation (ECMO) patients? A systematic review and meta-analysis","volume":"210","author":"D H Li","year":"2022","journal-title":"Thromb Res"},{"issue":"02","key":"ref6","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1177\/1060028014562949","article-title":"Efficacy and safety of argatroban and bivalirudine in patients with suspected heparin-induced thrombocytopenia","volume":"49","author":"Q A Vo","year":"2015","journal-title":"Ann Pharmacother"},{"issue":"04","key":"ref7","first-page":"303","article-title":"Intracranial haemorrhage in adult patients on venoarterial extracorporeal membrane oxygenation","volume":"11","author":"E L\u00fcsebrink","year":"2022","journal-title":"Eur Heart J Acute Cardiovasc Care"},{"issue":"38","key":"ref8","doi-asserted-by":"crossref","first-page":"3753","DOI":"10.1093\/eurheartj\/ehaa547","article-title":"Prevention and treatment of pulmonary congestion in patients undergoing venoarterial extracorporeal membrane oxygenation for cardiogenic shock","volume":"41","author":"E L\u00fcsebrink","year":"2020","journal-title":"Eur Heart J"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"S121","DOI":"10.1055\/s-0041-1735490","article-title":"S3 Guideline of extracorporeal circulation (ECLS\/ECMO) for cardiocirculatory failure","volume":"69","author":"U Boeken","year":"2021","journal-title":"Thorac Cardiovasc Surg"},{"issue":"10","key":"ref10","doi-asserted-by":"crossref","first-page":"1608","DOI":"10.1111\/jth.14575","article-title":"Heparin-induced thrombocytopenia complicating extracorporeal membrane oxygenation support: review of the literature and alternative anticoagulants","volume":"17","author":"U Pollak","year":"2019","journal-title":"J Thromb Haemost"},{"issue":"09","key":"ref11","doi-asserted-by":"crossref","first-page":"1460","DOI":"10.1007\/s00134-018-5346-y","article-title":"Prevalence and outcome of heparin-induced thrombocytopenia diagnosed under veno-arterial extracorporeal membrane oxygenation: a 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patients with newly implanted mechanical circulatory support devices","volume":"56","author":"L To","year":"2022","journal-title":"Ann Pharmacother"},{"issue":"12","key":"ref18","doi-asserted-by":"crossref","first-page":"2642","DOI":"10.1111\/j.1538-7836.2010.04059.x","article-title":"The HIT Expert Probability (HEP) Score: a novel pre-test probability model for heparin-induced thrombocytopenia based on broad expert opinion","volume":"8","author":"A Cuker","year":"2010","journal-title":"J Thromb Haemost"},{"issue":"11","key":"ref19","doi-asserted-by":"crossref","first-page":"1882","DOI":"10.1111\/j.1538-7836.2004.00949.x","article-title":"Diagnostic score for heparin-induced thrombocytopenia after cardiopulmonary bypass","volume":"2","author":"A Lillo-Le Lou\u00ebt","year":"2004","journal-title":"J Thromb Haemost"},{"issue":"07","key":"ref20","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1177\/0267659119842056","article-title":"Heparin-induced thrombocytopenia in patients 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