Abstract Number: PB1314
Meeting: ISTH 2020 Congress
Background: Children supported with mechanical support devices (MCS) experience bleeding and thrombotic complications that may depend upon anticoagulation strategies.
Aims: Our study aimed to evaluate the effects of bivalirudin administration on activated prothrombin time (Ptts), Lactate dehydrogenase (LDH) and free Hemoglobin (fHb) levels.
Methods: Fourteen (14) children were analyzed: 4 Berlin Heart (BH), 3 Infant Jarvik 2015 (IJ) and 7 extracorporeal membrane oxygenation (ECMO). Bivalirudin was prescribed to a Ptts target between 80 and 100 seconds.
Mean patients’ age and weight was 49.8 months (60.9) and 13.8 Kg (10.8), respectively.
Results: 1746 bivalirudin doses were retrospectively recorded. Mean (SD) dose of bivalirudin was 0.8 (0.4) mg/kg/h and mean (SD) Ptts was 81 (20) seconds. Requirement of bivalirudin dose varied between ECMO, BH and IJ (BH: 1 (0.41), IJ: 0.82 (0.48), ECMO 0.69 (0.45) mg/kg/h; p=0.0001). A significant correlation between Ptts values and bivalirudin doses was found in all patients, with the highest values in ECMO patients (r:0.43, p=0.0001). Over time, patients showed some variations on Ptts values that appeared rather stable around the target values with occasional oscillations in bivalirudin doses. Quartiles of Ptts targets (60-70, 70-80, 80-90, >90) were associated with a significant progressive anticoagulant increase (p=0.0001). LDH and fHb correlation was different between ECMO (r: 0.27, p=0.0001), IJ (r: 0.33, p= 0.0001) and BH (r: -0.24, p=0.003).
The lowest levels of both markers were found in BH patients (LDH 642.8(244.3) mMol/L; fHb 58.05 (41.11) g/L) vs ECMO (LDH 779.5 (712.4) mMol/L, fHb 77.6 (53.1) mg/L) vs IJ (LDH 1517 (915.2) mMol/L, fHb 103.3 (121.2) g/L) (p=0.0001).
Conclusions: Bivalirudin warrants stable Ptts levels with slightly different behavior among different MCS. It prevented severe thrombotic and hemorrhagic complications.
To cite this abstract in AMA style:Giorni C, Rizza A, Benegni S, Favia I, Vallesi L, Selvaggio D, Amodeo A, Di Chiara L, Ricci Z. Bivalirudin Administration in Pediatric Ventricular Assist Devices and in Pediatric ECMO [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/bivalirudin-administration-in-pediatric-ventricular-assist-devices-and-in-pediatric-ecmo/. Accessed May 6, 2021.
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