Systemic anticoagulation with bivalirudin in Impella 5.5 patients was associated with improved biocompatibility, fewer insertion site bleeds, and more time in target range (P≤.001).
Cohort
Does systemic anticoagulation with bivalirudin improve biocompatibility and reduce bleeding or thrombotic complications compared to heparin in patients supported on Impella 5.5 microaxial flow pumps?
In patients supported by Impella 5.5, an institutional shift to bivalirudin for systemic anticoagulation was associated with improved biocompatibility, less thrombocytopenia, and fewer insertion site bleeds compared to heparin.
p-value: p=≤ .001
Objective: To evaluate whether an institutional shift from anticoagulation with heparin to bivalirudin in Impella 5.5 patients altered bleeding or thrombotic rates, transfusion dependency, or device biocompatibility. Methods: All patients supported by an Impella 5.5 between August 2022 and December 2024 were reviewed retrospectively. Heparin was used before December 2023, at which point the switch was made to bivalirudin. Groups were defined by anticoagulant initiated by postimplantation day 2, and patients with crossover or anticoagulation pauses for >2 days were excluded from the laboratory analyses. Baseline characteristics, anticoagulation details, complications, and clinical outcomes were compared between the heparin and bivalirudin groups. Biocompatibility was assessed via laboratory values recorded over the first 14 days of Impella support or until device explantation in patients supported for <14 days. Results: ≤ .001). Conclusions: Systemic anticoagulation with bivalirudin in Impella 5.5 patients is associated with clinically meaningful improvements in postoperative thrombocytopenia and biocompatibility, with easier management, fewer insertion site bleeds, and more time within the target anticoagulation range.
Asher et al. (Sat,) conducted a cohort in Patients supported on microaxial flow pumps (Impella 5.5). Bivalirudin vs. Heparin was evaluated on Bleeding or thrombotic rates, transfusion dependency, or device biocompatibility (p=≤ .001). Systemic anticoagulation with bivalirudin in Impella 5.5 patients was associated with improved biocompatibility, fewer insertion site bleeds, and more time in target range (P≤.001).