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    Poster Networking

    Pediatrics

    Poster Networking Session

    PB0287 - Thromboembolic and hemorrhagic events in pediatric patients assisted with mechanical circulatory support and bivalirudin anticoagulation: a retrospective observational study

    Sunday, June 25, 2023
    18:30 – 19:30 ET
    Room: Exhibition
    Background: Children supported with mechanical circulatory support (MCS) devices experience bleeding and thrombotic complications that may depend upon anticoagulation strategies.

    Aims: The aim of this retrospective study was to describe the administration of bivalirudin for MCS anticoagulation in pediatric patients.

    Methods: The occurrence of major thromboembolic events were analyzed . Minor complications, i.e., the number of circuit changes and the effects of therapy modifications, were also reported.

    Results: Twenty-five patients were included: 10 were treated with extracorporeal membrane oxygenation (ECMO), 8 with Berlin Heart (BH), 3 with Infant Jarvik 2015 (IJ), 1 with Heartware, 2 with HeartMate III, and 1 with Jarvik 2000. Median (interquartile range) patients’ age and weight were 45 (10-24) months and 13.5 (7.5-30) Kg, respectively. Bivalirudin was prescribed to a activated thromboplastin time (aPTT) target between 80 and 100 seconds. Overall, were evaluated for 799 bivalirudin doses for ECMO (median value 0.56, 0.34-0.9 mg/kg/h), 637 doses (median value 1, 0.8-1.2 mg/kg/h) were available for BH, and 959 bivaluridin doses (median value 0.7, 0.42-1 mg/kg/h) were available for continuous flow MCS (p=0.001). In only 10% of cases an increase of bivalirudin was not followed by an increase in aPTT and in 6-8% of cases a reduction of bivalirudin dose did not imply a aPTT reduction. This pattern was not different among the three MCS types. During ECMO, unplanned circuit changes were very unusual. One hemorrhagic stroke occurred in a patient assisted with ECMO, attributable to an acquired cerebrovascular disease and resulting in patient death.
    Two minor ischemic strokes were described in patients assisted with BH, with no residual symptoms.

    Conclusion(s): Bivalirudin is an easily manageable drug in which modifications of dose generally imply a proportional change of anticoagulation, regardless of MCS type. Thromboembolic and hemorrhagic events occurred very rarely. Increasing experience with this drug makes it as an optimal choice.