Abstract Number: PB1292
Meeting: ISTH 2020 Congress
Background: The Berlin EXCOR ventricular assist device (VAD) is used primarily in the infant/toddler population for support in heart failure. Systemic anticoagulation is used to minimize hematologic complications with VAD use. There is little published literature regarding bivalirudin use in this patient population.
Aims: To describe patient outcomes with bivalirudin as the primary anticoagulant in the setting of Berlin EXCOR VAD use.
Methods: Retrospective case series of pediatric patients with VAD and bivalirudin as their primary anticoagulant. Data from initial insertion of the VAD and initiation of bivalirudin until VAD removal and bivalirudin discontinuation was collected. Patient demographics, dose, monitoring, and adverse reactions to bivalirudin were recorded.
Results: Eight patients were identified having bivalirudin as the primary anticoagulant during VAD use. Ages ranged from 2.5wks to 8 years. Four patients had complex congenital heart disease; four had cardiomyopathy/cardiac failure. Median days on VAD was 129 (range 24-351). Six patients had bivalirudin started within 2 days of VAD placement with two patients starting bivalirudin on day 7 after initially starting on heparin. All patients reached therapeutic range after 5 dose adjustments with 5 patients needing none. Median number of dose adjustments to stay within therapeutic range was 14.5 (range 9-84). Median percentage of days within therapeutic range was 98.9%. Two patients required device change due to thrombus. Six patients had no bleeding events, one patient had 3 bleeding events (GI bleed x2 and mediastinal bleed), and one had one bleeding event. Five patients received heart transplants, two patients had VAD removed due to needing ECMO support, and one patient died with VAD in place. Cause of death was hemorrhage, though not attributed to anticoagulation.
Conclusions: Bivalirudin was effectively used in patients with VAD. Dose adjustments were infrequently needed, and most patients did not have any significant device thrombus or bleeding events.
|Patient 1||Patient 2||Patient 3||Patient 4||Patient 5||Patient 6||Patient 7||Patient 8|
|Age at VAD Placement||11mo||13mo||3mo||5wks||8yo||2.5wks||15mo||12mo|
|Cardiac Diagnosis||Complex Congenital Heart Disease||Dilated Cardiomyopathy||Heart Failure Secondary to Aortic Stenosis||Dilated Cardiomyopathy||Complex Congenital Heart Disease||Enterovirus Myocarditis||Complex Congenital Heart Disease||Complex Congenital Heart Disease|
|VAD Removal Reason||Heart Transplant||Heart Transplant||Heart Transplant||Death due to infected VAD cannula site hemorrhage||Transitioned to ECMO||Heart Transplant||Heart Transplant||Transitioned to ECMO|
To cite this abstract in AMA style:Silvey M, Barnes A, Carpenter S. Bivalirudin as the Primary Anticoagulant for Pediatric Patients with a Berlin EXCOR Ventricular Assist Device (VAD) [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/bivalirudin-as-the-primary-anticoagulant-for-pediatric-patients-with-a-berlin-excor-ventricular-assist-device-vad/. Accessed January 26, 2022.
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