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In Vitro Thrombosis Test for Ventricular Assist Devices
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Bivalirudin or Unfractionated Heparin for Anticoagulation in Pediatric Patients on Continuous Flow Ventricular Assist

Kriti Puri1,2, Hari P Tunuguntla2, Lisa A Hensch3

  • 1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|June 10, 2022
PubMed

Insights

Bivalirudin use in pediatric continuous flow ventricular assist device (VAD) patients showed fewer bleeding complications than unfractionated heparin (UFH). Bivalirudin also helped manage pump thrombosis in most cases.

Area of Science:

  • Pediatric cardiology
  • Cardiovascular surgery
  • Pharmacology

Background:

  • Bivalirudin is increasingly used for anticoagulation in children with ventricular assist devices (VADs).
  • Limited data exist on bivalirudin use in continuous flow (CF) VADs and its comparison to unfractionated heparin (UFH).

Purpose of the Study:

  • To compare the safety and efficacy of bivalirudin versus UFH for anticoagulation in pediatric patients with CF-VADs.
  • To evaluate outcomes including bleeding, thrombosis, and hemolysis.

Main Methods:

  • Retrospective cohort study of pediatric patients (<21 years) on CF-VADs from 2016-2020.
  • Compared clinical characteristics and adverse events between patients receiving bivalirudin or UFH.
  • Analyzed time to therapeutic anticoagulation, hemolysis markers, and hemocompatibility-related events.

Main Results:

  • Bivalirudin use was associated with significantly lower odds of major bleeding complications compared to UFH (OR, 0.29; p=0.038).
  • No significant difference was found in the odds of major thrombotic complications between the two anticoagulants (OR, 2.53; p=0.450).
  • Bivalirudin was effective as a "washout" strategy, resolving pump thrombosis in 6 of 8 cases.

Conclusions:

  • Bivalirudin is associated with reduced hemorrhagic complications in pediatric CF-VAD patients compared to UFH.
  • Bivalirudin serves as a viable option for anticoagulation and management of potential pump thrombosis in this population.
Abstract

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