Comparison of the efficacy and safety of anticoagulation therapy with bivalirudin and heparin in adult patients receiving extracorporeal membrane oxygenation support after cardiac surgery

Wang Rui; Ren Yucheng; Li Ying; Zhou Wangtao; Tong Yaowei; Yuan Xin; Yang Zikai; Xu Tianwei; Song Yunlin

doi:10.3760/j.issn.1673-4777.2025.02.006

Abstract：Objective To investigate the efficacy and safety of anticoagulation therapy with bivalirudin and heparin in adult patients receiving extracorporeal membrane oxygenation(ECMO)support after cardiac surgery.Methods The clinical data of 56 patients receiving ECMO support after adult cardiac surgery at the Department of Critical Care Medicine Center,the First Affiliated Hospital of Xinjiang Medical University from March 2018 to June 2024 were retrospectively analyzed.According to the application of anticoagulant drugs during ECMO support,patients were divided into heparin group(25 cases)and bivalirudin group(31 cases).The baseline data and outcome indicators of the two groups were collected,and the ECMO support time,platelet count,coagulation indicators,the rate of successful ECMO withdrawal,in-hospital mortality and survival at 90 d of follow-up were compared between the two groups.Results There were no significant differences in age,gender,body mass index,ECMO mode,platelet count,activated partial thromboplastin time(APTT)before ECMO,and acute physiology and chronic health evaluation Ⅱ score before ECMO between the two groups(all P＞0.05).In terms of outcome measures,there were no significant differences in the duration of ECMO support,mean hemoglobin value,APTT during ECMO support,coagulation time of activated whole blood during ECMO support,plasma transfusion volume,and the incidence of thrombosis,minor bleeding,and severe bleeding complications between the two groups(all P＞0.05).The lowest platelet count,platelet count,the lowest hemoglobin,and the rate of successful ECMO withdrawal in the bivalirudin group were higher than those in the heparin group,and the amount of red blood cell transfusion,platelet transfusion and in-hospital mortality in the heparin group were less than/lower than those in the heparin group(all P＜0.05).The results of cross-effect analysis showed that there was no interaction between group and before and after treatment,that is,the treatment effect of the two groups had the same trend on the effect of ACT(Fcross=0.509,P=0.799).A total of 25 patients(80.6％)in the bivalirudin group and 13 patients(52.0％)in the heparin group were alive at day 90,with a higher overall survival rate in the bivalirudin group than in the heparin group(Log-rank x2=6.174,P=0.013).Conclusion In adult patients receiving ECMO support after cardiac surgery,bivalirudin has the same anticoagulant effect as heparin,and can reduce blood product transfusion volume and in-hospital mortality,increase the probability of successful ECMO withdrawal,and improve the safety of anticoagulation therapy.