Fetal Diagn Ther

. 2024 Nov 26:1-10.

 doi: 10.1159/000542760. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/39591954/

Bleeding Complications between Bivalirudin and Heparin for ECMO in Neonates with CDH

Caroline Credille, Caitlin R Eason, Lauren L Evans, Samantha Bothwell, Jason Gien, Alyssa E Vaughn, John P Kinsella, Pavika Varma, Kenneth W Liechty, S Christopher Derderian

• PMID: 39591954
• DOI: 10.1159/000542760

Abstract

Introduction: Infants with congenital diaphragmatic hernia (CDH) who undergo repair while on extracorporeal membrane oxygenation (ECMO) are at risk for developing post-operative bleeding complications. Balanced anticoagulation is critical to maintain ECMO flow and avoid bleeding. Heparin has historically been our first-line anticoagulant; however, recently, we transitioned to bivalirudin, a direct thrombin inhibitor. The objective of this pilot study was to compare post-operative surgical bleeding complications between the two groups.

Methods: A single center retrospective cohort study of patients who underwent CDH repair while on ECMO between 2008-2023 was performed. Neonates were stratified based on type of anticoagulant initiated after CDH repair. Outcomes included bleeding requiring surgical re-operation, intracranial hemorrhage, volume of blood products transfused, number of circuit changes, days on ECMO, and overall survival.

Results: Among 62 infants with CDH who underwent repair on ECMO, 44 (71%) were managed post-CDH repair with heparin and 18 (29%) with bivalirudin. Demographics and prenatal predictors of CDH severity were not significantly different between the two cohorts. One (5.6%) neonate managed with bivalirudin required re-operation following CDH repair for a bleeding complication compared to 17 (38.6%) managed with heparin (p=0.022). In addition, the bivalirudin cohort required half of the total blood product volume compared to the heparin cohort (p=0.020). Despite these benefits, there were no significant differences between groups for incidence of intracranial hemorrhage, number of circuit changes, days on ECMO, and overall survival.

Conclusion: Anticoagulation with bivalirudin in neonates who underwent CDH repair while on ECMO was associated with decreased surgical bleeding complications and less total blood product transfused. This pilot analysis is the first to directly compare heparin to bivalirudin and stresses the importance of a randomized trial.

S. Karger AG, Basel.