LAUSR

Objectives To compare heparin-based anticoagulation and bivalirudin-based anticoagulation within the context of critically ill patients with SARS-CoV-2 infection. Design Observational study. Setting Intensive care unit of a University hospital. Participants and interventions Critically ill SARS-CoV-2 patients receiving full coagulation with heparin or bivalirudin. Measurements and main results Twenty-three patients received full anticoagulation with bivalirudin and 60 with heparin. Despite patients in the bivalirudin group had higher mortality risk scores (SAPS II was 60 ± 16 vs 39 ±7, p <0.001) and higher need of extracorporeal support compared to heparin group, hospital mortality was comparable (57% vs 45, p=0.3). No difference in thromboembolic complications was observed, and bleeding events were more frequent in patients treated with bivalirudin (65% vs 40%,p=0.01). Similar results were confirmed in the subgroup analysis of patients undergoing intravenous anticoagulation: in addiction to comparable thrombotic complications occurrence and thrombocytopenia rate, however, no difference in bleeding rate was observed (65% vs 35%, p=0.08). Conclusions Although heparin is the most used anticoagulant in the intensive care setting, a bivalirudin-based anticoagulation was safe and effective in a cohort of SARS-CoV-2 critically ill patients. Bivalirudin may be given full consideration as anticoagulation strategy for SARS-CoV-2 critically ill patients, especially in those with thrombocytopenia and on extracorporeal support.