This study evaluated differences in efficacy and safety outcomes with bivalirudin compared with unfractionated heparin (UFH) in patients with cardiogenic shock requiring venoarterial extracorporeal membrane oxygenation (VA ECMO). We performed a retrospective study at an academic medical center that included patients greater than 18 years of age supported with VA ECMO due to cardiogenic shock from January 2009 to February 2021. The primary endpoint was ECMO-associated thrombotic events normalized to duration of ECMO support. Secondary safety endpoints included major bleeding (per ELSO criteria) and blood product administration. Overall, 143 patients were included in our analysis with 54 having received bivalirudin and 89 having received UFH. Median duration of ECMO support was 92 (interquartile range, 56-172) hours. ECMO-associated thrombotic events per ECMO day were significantly less among those that received bivalirudin ( P < 0.001). In adjusted regression, bivalirudin was independently associated with an increased time to thrombosis when compared with UFH (Exp[B] -3.8; 95% confidence interval, 1.7-8.8; P = 0.002). Patients receiving bivalirudin experienced less major bleeding events ( P = 0.02) with less total red blood cell and fresh frozen plasma administration ( P = 0.04 and P = 0.03, respectively). Bivalirudin is a safe and efficacious alternative to UFH in patients requiring VA ECMO for cardiogenic shock.

中文翻译：

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比伐卢定与普通肝素在需要静脉动脉体外膜氧合的心源性休克患者中的应用。

本研究评估了比伐卢定与普通肝素 (UFH) 在需要静脉动脉体外膜肺氧合 (VA ECMO) 的心源性休克患者中疗效和安全性结果的差异。我们在学术医学中心进行了一项回顾性研究，该研究纳入了 2009 年 1 月至 2021 年 2 月期间因心源性休克而接受 VA ECMO 支持的 18 岁以上患者。主要终点是 ECMO 相关血栓事件，这些事件归一化为 ECMO 支持的持续时间。次要安全终点包括大出血（根据 ELSO 标准）和血液制品给药。总体而言，我们的分析包括 143 名患者，其中 54 名接受了比伐卢定，89 名接受了 UFH。ECMO 支持的中位持续时间为 92（四分位间距，56-172）小时。在接受比伐卢定的患者中，每个 ECMO 日的 ECMO 相关血栓形成事件显着减少（P < 0.001）。在调整回归中，与 UFH 相比，比伐卢定与血栓形成时间增加独立相关（Exp[B] -3.8；95% 置信区间，1.7-8.8；P = 0.002）。接受比伐卢定治疗的患者大出血事件较少 (P = 0.02)，总红细胞和新鲜冰冻血浆给药较少（分别为 P = 0.04 和 P = 0.03）。对于需要 VA ECMO 治疗心源性休克的患者，比伐卢定是 UFH 的安全有效替代品。95%置信区间，1.7-8.8；P = 0.002）。接受比伐卢定治疗的患者大出血事件较少 (P = 0.02)，总红细胞和新鲜冰冻血浆给药较少（分别为 P = 0.04 和 P = 0.03）。对于需要 VA ECMO 治疗心源性休克的患者，比伐卢定是 UFH 的安全有效替代品。95%置信区间，1.7-8.8；P = 0.002）。接受比伐卢定治疗的患者大出血事件较少 (P = 0.02)，总红细胞和新鲜冰冻血浆给药较少（分别为 P = 0.04 和 P = 0.03）。对于需要 VA ECMO 治疗心源性休克的患者，比伐卢定是 UFH 的安全有效替代品。