LAUSR

Introduction/Hypothesis: Anticoagulation for patients with indications for VA ECMO is imperative for circuit maintenance prevention of thrombotic events during extracorporeal support. There is no current standard for preferential anticoagulant or laboratory test for use with respect to AC in patients with ECMO circuits. The purpose of this study is to compare bivalirudin and unfractionated heparin in therapeutic AC target attainment in patients on VA ECMO. Methods: Single center, retrospective cohort study of patients that are greater than 18 years of age and require therapeutic AC for VA ECMO for at least 24 hours. Patients were excluded from the study if they have a known coagulation disorder at baseline, have irreversible neurological impairment, active malignancy, advanced cirrhosis, or a contraindication to systemic anticoagulation. Demographics, concomitant circulatory support, indications for bivalirudin use, and therapeutic laboratory monitoring goals were extracted from the EMR. Therapeutic AC was assessed based on percentage within goal range based on institutional standards which was the primary endpoint. Secondary endpoints were clinically defined major bleeding, clinically relevant thrombotic events, inhospital mortality, ICU length of stay, and hospital length of stay. Results: A total of 114 patients were screened with 50 included. 12 patients received bivalirudin and 38 patients received heparin. Baseline characteristics were similar between the groups except for Caucasian race with the heparin group having more Caucasian patients (78% vs 42% p < 0.01). Therapeutic laboratory markers for monitoring and concomitant mechanical support were recorded but not compared between groups. There were no difference in the bivalirudin and heparin groups for mean percent within goal (55 vs 49%), hospital LOS (27 vs 18 days), time to first therapeutic lab (8 vs 6 hours), major bleeding (6 vs 21), in-hospital mortality (8 vs 23), or thrombosis (2 vs 2). Patients with heparin had less ECMO duration (119 vs 272 hrs), decreased ICU LOS (13.5 vs 22.5 days), and longer time spent on AC (100 vs 73 hrs). Conclusions: Bivalirudin and heparin are both safe and efficacious for us in VA ECMO, there is no difference in time within therapeutic range, many factors including anticoagulant may impact ICU LOS and ECMO duration