Impact of Continuous Renal Replacement Therapy on Bivalirudin Dosing in Pediatric Extracorporeal Membrane Oxygenation

Area of Science:

• Pediatric critical care medicine
• Pharmacology and therapeutics
• Nephrology

Background:

• Bivalirudin is increasingly used for anticoagulation in pediatric extracorporeal membrane oxygenation (ECMO).
• Optimal bivalirudin dosing in pediatric ECMO patients also requiring continuous renal replacement therapy (CRRT) is not well-established.
• Understanding factors influencing bivalirudin dosing is crucial for patient safety and treatment efficacy.

Purpose of the Study:

• To investigate the impact of CRRT on bivalirudin dosing requirements in pediatric ECMO patients.
• To identify potential correlations between CRRT, patient age, weight, and bivalirudin dosage.
• To provide evidence-based guidance for bivalirudin anticoagulation in this complex patient population.

Main Methods:

• Retrospective analysis of pediatric patients (≤18 years) on ECMO and bivalirudin for ≥24 hours (January 2019 - May 2020).
• Bivalirudin doses were recorded for 144 hours from initiation of bivalirudin or CRRT.
• Statistical analysis to compare bivalirudin dosing between patients with and without CRRT, considering age and weight.

Main Results:

• Eleven out of thirty-one (35%) pediatric ECMO patients required concomitant CRRT.
• No significant difference in bivalirudin mean dosing was observed between patients with and without CRRT (0.13 mg/kg/hr vs. 0.15 mg/kg/hr, p=0.13).
• Younger age (p<0.001) and lower weight (p<0.001) were significantly associated with higher bivalirudin dosing requirements.

Conclusions:

• Concomitant CRRT does not appear to significantly alter bivalirudin dosing needs in pediatric ECMO patients.
• Bivalirudin dosage adjustments in pediatric ECMO should primarily consider patient age and weight.
• Further research may refine dosing strategies for bivalirudin in critically ill children undergoing ECMO and CRRT.