2025 Southeastern Residency Conference

Title: A comparison of bivalirudin versus unfractionated heparin for anticoagulation in adult patients requiring venoarterial extracorporeal membrane oxygenation


Authors: Landry Slaughter, PharmD, MMHC; Andrew McRae, PharmD, BCCCP; Lindsey Tolbert, PharmD, BCCP; Aaron Williams, MD; Michelle Miller, PharmD, BCCCP


Background: Extracorporeal membrane oxygenation (ECMO) is a form of life support in patients with cardiac and/or respiratory insufficiency that precludes adequate gas exchange or perfusion. Cannulation onto the ECMO device is an invasive procedure, in which the mechanical design of the circuit allows nonbiologic material to interface with blood creating a highly thrombogenic process. It is imperative to anticoagulate these patients to mitigate thrombosis and manage the leading complication of systemic anticoagulation, bleeding. Despite the recognition of this challenge by the Extracorporeal Life Support Organization (ELSO), minimal high-quality, prospective literature has been published. What exists is retrospective in nature, and anticoagulation is evaluated in mixed ECMO configurations, isolated pediatric, or mixed adult and pediatric populations, or isolates specific ECMO indications, such as cardiogenic shock. This gap in literature leaves uncertainty concerning the most safe and effective anticoagulation strategies in non-cardiogenic shock indications for adult venoarterial ECMO. 


Methods: This retrospective study was performed from May 2021 to September 2024 at an academic medical center that included adult patients supported with venoarterial ECMO (VA-ECMO). The primary outcome was the incidence of in-circuit thrombosis per ECMO day defined as the incidence of oxygenator exchange. Secondary safety outcomes included bleeding per ELSO criteria and thrombotic complications. 


Results: In progress


Conclusion: In progress