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. 2023 Feb 6;9(2):e13530.
doi: 10.1016/j.heliyon.2023.e13530. eCollection 2023 Feb.

Superiority of bivalirudin over heparin anticoagulation therapy for extracorporeal membrane oxygenation? Too early to draw conclusions

Jie Gu  1 , Hongjie Yu  2 , Dang Lin  1
Affiliations

Superiority of bivalirudin over heparin anticoagulation therapy for extracorporeal membrane oxygenation? Too early to draw conclusions

Jie Gu et al. Heliyon. .

Abstract

Background: We aimed to compare the efficacy and safety of bivalirudin versus heparin as the anticoagulant in patients undergoing extracorporeal membrane oxygenation (ECMO).

Methods: We conducted a search in PubMed, Embase and the Cochrane Library for all the studies in which bivalirudin was compared to heparin as the anticoagulant for ECMO. Efficacy outcomes were defined as the time to reach therapeutic levels, time within therapeutic range (TTR), thrombotic events, circuit thrombosis, circuit exchanges. Safety outcomes were reported as heparin-induced thrombocytopenia (HIT), major bleeding events, minor bleeding events. Other outcomes included hospital length of stay (LOS), ICU LOS, mortality, 30-day mortality and in-hospital mortality.

Results: Ten studies with 1091 patients were included for meta-analysis. A significant reduction in thrombotic events [OR 0.51, 95%CI 0.36,0.73, p = 0.0002, I2 = 0%], major bleeding events [OR 0.31, 95%CI 0.10,0.92, p = 0.04, I2 = 75%] and in-hospital mortality [OR 0.63, 95%CI 0.44,0.89, p = 0.009, I2 = 0%] treated with bivalirudin were found compared with heparin. There were no significant differences between groups regarding the time to reach therapeutic levels [MD 3.53, 95%CI -4.02,11.09, p = 0.36, I2 = 49%], TTR [MD 8.64, 95%CI -1.72,18.65, p = 0.10, I2 = 77%], circuit exchanges [OR 0.92, 95%CI 0.27,3.12, p = 0.90, I2 = 38%], HIT [OR 0.25, 95%CI 0.02,2.52, p = 0.24, I2 = 0%], minor bleeding events [OR 0.93, 95%CI 0.38,2.29, p = 0.87, I2 = 0%], hospital LOS [MD -2.93, 95%CI -9.01,3.15, p = 0.34, I2 = 45%], ICU LOS [MD -4.22, 95%CI -10.07,1.62, p = 0.16, I2 = 0%], mortality [OR 1.84, 95%CI 0.58,5.85, p = 0.30, I2 = 60%] and 30-day mortality [OR 0.75, 95%CI 0.38,1.48, p = 0.41, I2 = 0%].

Conclusion: Bivalirudin probably be a potential choice for ECMO anticoagulation. However, based on the included studies' limitation, the superiority of bivalirudin over heparin for anticoagulation in the ECMO population still require further prospective randomized controlled studies before a definite conclusion.

Keywords: Bivalirudin; ECMO; Heparin; Major bleeding events; Mortality; Thrombotic events.

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Conflict of interest statement

The authors declared that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the search process.
Fig. 2
Fig. 2
Forest plot for the time to reach therapeutic levels, TTR, thrombotic events, circuit thrombosis and circuit exchanges.
Fig. 3
Fig. 3
Forest plot for HIT, major bleeding events and minor bleeding events.
Fig. 4
Fig. 4
Forest plot for hospital LOS, ICU LOS, mortality, 30-day mortality and in-hospital mortality.
See this image and copyright information in PMC

References

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