Anticoagulation with direct thrombin inhibitors during extracorporeal membrane oxygenation

Table 1 Pharmacology of direct thrombin inhibitors

	Valence	Thrombin binding	Onset of action	Half-life	Protein binding	Metabolism	Special considerations
Bivalirudin	Bivalent	Reversible	2-4 min	25 min	None	Serum proteases	Avoid during low-flow states Removed by non-diffusive dialysis modalities Dose reductions necessary in renal dysfunction
Argatroban	Univalent	Reversible	30 min	45 min	20% albumin 34% alpha-acid glycoprotein	Hepatic (hydroxylation, aromatization)	Dose reductions necessary in hepatic dysfunction