Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Oct 16, 2019; 8(6): 87-98
Published online Oct 16, 2019. doi: 10.5492/wjccm.v8.i6.87
Anticoagulation with direct thrombin inhibitors during extracorporeal membrane oxygenation
Barry Burstein, Patrick M Wieruszewski, Yan-Jun Zhao, Nathan Smischney
Barry Burstein, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States
Patrick M Wieruszewski, Yan-Jun Zhao, Department of Pharmacy, Mayo Clinic, Rochester, MN 55905, United States
Nathan Smischney, Department of Anesthesia, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Nathan Smischney, MD, MSc, Assistant Professor, Department of Anesthesia, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States.
Telephone: +1-507-2554305 Fax: +1-507-2554267
Received: April 28, 2019
Peer-review started: May 9, 2019
First decision: August 2, 2019
Revised: August 13, 2019
Accepted: September 5, 2019
Article in press: September 5, 2019
Published online: October 16, 2019
Core Tip

Core tip: In contrast to unfractionated heparin, direct thrombin inhibitors are not associated with heparin-induced thrombocytopenia or acquired antithrombin deficiency. Direct thrombin inhibitors, specifically bivalirudin and argatroban, are equally safe and possibly more efficacious than unfractionated heparin. Dosage and monitoring parameters are easily manageable and more predictable than unfractionated heparin. As extracorporeal membrane oxygenation increases in use, direct thrombin inhibitors may potentially be considered as a primary anticoagulant in patients with or without complications of unfractionated heparin.