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Bivalirudin or heparin for systemic anticoagulation during pediatric extracorporeal membrane oxygenation: Multicenter

Mohammed Hamzah1, Troy G Seelhammer2, Asaad G Beshish3

  • 1Department of Pediatric Critical Care, Cleveland Clinic Children's, Cleveland, OH, USA.

Thrombosis Research
|July 30, 2023
PubMed

Insights

Bivalirudin anticoagulation in pediatric ExtraCorporeal Membrane Oxygenation (ECMO) showed lower bleeding and thrombotic events. This anticoagulant also improved survival and neurological outcomes compared to unfractionated heparin (UFH).

Area of Science:

  • Pediatric critical care medicine
  • Cardiovascular research
  • Pharmacology and therapeutics

Background:

  • Pediatric ExtraCorporeal Membrane Oxygenation (ECMO) requires effective anticoagulation.
  • Unfractionated heparin (UFH) is a common anticoagulant, but can be associated with complications.
  • Alternative anticoagulants like bivalirudin are being explored for pediatric ECMO.

Purpose of the Study:

  • To compare the efficacy and safety of bivalirudin versus UFH in pediatric patients on ECMO.
  • To evaluate outcomes including bleeding, thrombosis, blood product transfusion, hospital survival, and neurological function.

Main Methods:

  • A multicenter retrospective study of pediatric patients (<18 years) on ECMO from June 2017 to May 2020.
  • Patients on UFH were matched 2:1 to patients on bivalirudin based on age and ECMO type.
  • Outcomes were analyzed comparing the two anticoagulant groups.

Main Results:

  • Bivalirudin use was associated with significantly lower odds of bleeding events (aOR 0.23) and thrombotic events (aOR 0.48).
  • Patients on bivalirudin required fewer transfusions of fresh frozen plasma and platelets.
  • Bivalirudin was linked to a 50% decrease in hospital mortality (aOR 0.50) and higher odds of intact neurological outcomes (OR 1.99).

Conclusions:

  • Bivalirudin provides effective anticoagulation in pediatric ECMO with reduced bleeding and blood product use.
  • Bivalirudin is associated with improved hospital survival and neurological function compared to UFH.
  • Further validation through a prospective randomized trial is recommended.
Abstract

Keywords:
AnticoagulationBivalirudinHeparinPediatric extracorporeal membrane oxygenation

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