Comparison of bleeding and thrombotic outcomes in veno‐venous extracorporeal membrane oxygenation: Heparin versus bivalirudin

Abstract

AbstractObjectivesWe aimed to evaluate thrombotic and hemorrhagic complications with heparin versus bivalirudin use in veno‐venous extracorporeal membrane oxygenation (V‐V ECMO).MethodsWe performed a retrospective cohort study of adult patients placed on V‐V ECMO with intravenous anticoagulation with either heparin or bivalirudin. Time to thrombotic event and major bleed were analyzed in addition to related outcomes.ResultsWe identified 95 patients placed on V‐V ECMO: 61 receiving heparin, 34 bivalirudin. The bivalirudin group had a higher rate of severe COVID‐19, higher BMI, and longer ECMO duration. Despite this, bivalirudin was associated with reduced risk of thrombotic event (HR 0.14, 95% CI 0.06–0.32, p < .001) and increased average lifespan of the circuit membrane lung (16 vs. 10 days, p = 0.004). While there was no difference in major bleeding, the bivalirudin group required fewer transfusions of packed red blood cells and platelets per 100 ECMO days (means of 13 vs. 39, p = 0.004; 5 vs. 19, p = .014, respectively). Lastly, the bivalirudin group had improved survival to ECMO decannulation in univariate analysis (median OS 53 vs. 26 days, p = .015).ConclusionsIn this real‐world analysis of bivalirudin versus heparin, bivalirudin is a viable option for V‐V ECMO and associated with lower risk of thrombotic complications and fewer transfusion requirements.