PMID- 37517208
OWN - NLM
STAT- Publisher
LR  - 20230901
IS  - 1879-2472 (Electronic)
IS  - 0049-3848 (Linking)
VI  - 229
DP  - 2023 Sep
TI  - Bivalirudin or heparin for systemic anticoagulation during pediatric 
      extracorporeal membrane oxygenation: Multicenter retrospective study.
PG  - 178-186
LID - S0049-3848(23)00224-4 [pii]
LID - 10.1016/j.thromres.2023.07.012 [doi]
AB  - BACKGROUND: The objective of this study is to evaluate the outcomes of 
      unfractionated heparin (UFH) compared to bivalirudin anticoagulation in pediatric 
      ExtraCorporeal Membrane Oxygenation (ECMO). METHODS: A multicenter retrospective 
      study, that included pediatric patients <18 years of age, who were supported on 
      ECMO between June 2017 and May 2020. Patients treated with UFH were matched 2:1 
      by age and type of ECMO support to the bivalirudin group. RESULTS: The 
      bivalirudin group (75 patients) were matched to 150 patients treated with UFH. 
      Baseline characteristics and comorbidities of the two groups were similar. 
      Veno-Arterial ECMO was the most common mode (141/225 [63 %]) followed by 
      extracorporeal cardiopulmonary resuscitation (48/225 [21 %]). Bivalirudin 
      treatment was associated with lower odds of bleeding events (aOR 0.23, 95%CI 
      0.12-0.45, p < 0.001) and lower odds of thrombotic events (aOR 0.48, 95%CI 
      0.23-0.98, p = 0.045). Patients who received bivalirudin had lesser odds for 
      transfusion with fresh frozen plasma, and platelets (aOR 0.26, CI 0.12-0.57, 
      p </=0.001 and aOR 0.28, CI 0.15-0.53, p < 0.001, respectively). After adjusting 
      for the type of ECMO support and adjusting for age, bivalirudin was associated 
      with a decrease in hospital mortality by 50 % compared to the UFH group (aOR 
      0.50, 95%CI 0.27-0.93, p = 0.028). Similarly, for neurological disability at time 
      of discharge, bivalirudin was associated with higher odds of intact neurological 
      outcomes compared to UFH (OR 1.99 [95%CI 1.13-3.51], p = 0.017). CONCLUSIONS: 
      This study demonstrated that effective anticoagulation can be achieved with 
      bivalirudin, which was associated with lesser odds of bleeding events and 
      utilization of blood products. Bivalirudin, in comparison with UFH, was 
      associated with greater odds of hospital survival and intact neurological 
      function at the time of discharge. A prospective randomized trial is required to 
      validate the results of this study.
CI  - Copyright (c) 2023 Elsevier Ltd. All rights reserved.
FAU - Hamzah, Mohammed
AU  - Hamzah M
AD  - Department of Pediatric Critical Care, Cleveland Clinic Children's, Cleveland, 
      OH, USA. Electronic address: mhamzah@sidra.org.
FAU - Seelhammer, Troy G
AU  - Seelhammer TG
AD  - Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, 
      MN, USA.
FAU - Beshish, Asaad G
AU  - Beshish AG
AD  - Children's Healthcare of Atlanta, Department of Pediatrics, Division of 
      Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
FAU - Byrnes, Jonathan
AU  - Byrnes J
AD  - Department of Pediatric Cardiology, Children's of Alabama, Birmingham, AL, USA.
FAU - Yabrodi, Mouhammad
AU  - Yabrodi M
AD  - Department of Pediatrics Critical Care, Indiana University, Riley Hospital for 
      Children, Indiana University Health Physicians, Indianapolis, IN, USA.
FAU - Szadkowski, Adam
AU  - Szadkowski A
AD  - Departments of Pediatrics, Section of Critical Care, Medical College of 
      Wisconsin, Milwaukee, WI, USA.
FAU - Lutfi, Riad
AU  - Lutfi R
AD  - Department of Pediatrics Critical Care, Indiana University, Riley Hospital for 
      Children, Indiana University Health Physicians, Indianapolis, IN, USA.
FAU - Andrijasevic, Nicole
AU  - Andrijasevic N
AD  - Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, 
      MN, USA.
FAU - Hock, Kristal
AU  - Hock K
AD  - Department of Pediatric Cardiology, Children's of Alabama, Birmingham, AL, USA.
FAU - Worley, Sarah
AU  - Worley S
AD  - Department of Quantitative Health Sciences, Cleveland Clinic Children's, 
      Cleveland, OH, USA.
FAU - Macrae, Duncan J
AU  - Macrae DJ
AD  - Department of Pediatric Intensive Care, Royal Brompton and Harefield NHS 
      Foundation Trust, London, UK.
LA  - eng
PT  - Journal Article
DEP - 20230724
PL  - United States
TA  - Thromb Res
JT  - Thrombosis research
JID - 0326377
SB  - IM
OTO - NOTNLM
OT  - Anticoagulation
OT  - Bivalirudin
OT  - Heparin
OT  - Pediatric extracorporeal membrane oxygenation
COIS- Declaration of competing interest The authors declare that they have no known 
      competing financial interests or personal relationships that could have appeared 
      to influence the work reported in this paper.
EDAT- 2023/07/31 00:41
MHDA- 2023/07/31 00:41
CRDT- 2023/07/30 18:05
PHST- 2022/11/02 00:00 [received]
PHST- 2023/03/23 00:00 [revised]
PHST- 2023/07/19 00:00 [accepted]
PHST- 2023/07/31 00:41 [pubmed]
PHST- 2023/07/31 00:41 [medline]
PHST- 2023/07/30 18:05 [entrez]
AID - S0049-3848(23)00224-4 [pii]
AID - 10.1016/j.thromres.2023.07.012 [doi]
PST - ppublish
SO  - Thromb Res. 2023 Sep;229:178-186. doi: 10.1016/j.thromres.2023.07.012. Epub 2023 
      Jul 24.