Key result
Bivalirudin shows similar bleeding and thrombosis to UFH during ECMO but yields higher therapeutic time.
Why the study?
Unfractionated heparin is traditionally the anticoagulant of choice during ECMO but has inadequacies, prompting the evaluation of direct thrombin inhibitors such as bivalirudin.
Does bivalirudin improve safety and efficacy compared to unfractionated heparin in adult patients on ECMO?
Cohort
Does bivalirudin improve safety and efficacy compared to unfractionated heparin in adult patients on ECMO?
Absolute Event Rate: 6% vs 10%
p-value: p=0.44
In adult ECMO patients, bivalirudin demonstrates a more favorable pharmacokinetic profile with better maintenance of therapeutic range and similar safety outcomes compared to unfractionated heparin.
Bivalirudin was associated with superior anticoagulation metrics versus UFH in ECMO; leaves open whether this improves clinical outcomes in randomized trials.
Extracorporeal membrane oxygenation (ECMO) contributes to coagulopathy, necessitating systemic anticoagulation to prevent thrombosis. Traditionally, unfractionated heparin (UFH) has been the anticoagulant of choice, however, due to many inadequacies new evidence suggests benefit with the use of direct thrombin inhibitors. This retrospective cohort sought to evaluate the safety and efficacy of bivalirudin compared to UFH in ECMO patients. Primary endpoints included incidence of bleeding and thrombosis. Percent time in therapeutic range (TR), time to achieve TR and number of dose titrations required to maintain TR were calculated to assess efficacy of institutional protocols. Overall incidence of thrombosis was low, with one event in the bivalirudin group and no events in the UFH group. No difference was found in rates of bleeding between groups (6% vs . 10%, P = 0.44). Bivalirudin yielded higher percent time in TR (86% vs. 33%, P < 0.001), faster time to TR (2 vs . 18 hr, P < 0.001) and required fewer dose adjustments to maintain TR (2 vs . 11, P < 0.001) compared to UFH. These results suggest bivalirudin and UFH are associated with similar rates of bleeding and thrombosis in patients requiring ECMO support. Our results demonstrate the favorable pharmacokinetic profile of bivalirudin, and its ability to consistently maintain TR when compared to UFH.
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Sheridan et al. (2021) conducted a cohort in Extracorporeal Membrane Oxygenation. Bivalirudin vs. Unfractionated heparin (UFH) was evaluated on incidence of bleeding (p=0.44). Bivalirudin was associated with similar rates of bleeding (6% vs 10%, P=0.44) and thrombosis compared to unfractionated heparin in patients on ECMO, but yielded higher time in therapeutic range.
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