PSHP 2026 Residency Conference

PURPOSE: The purpose of this study is to evaluate the safety and efficacy of bivalirudin versus heparin as anticoagulation for patients receiving either VA or VV ECMO. 
 
METHODS: This single center, retrospective chart review evaluated patients at Temple University Hospital between June 1st, 2019 to June 30th, 2025 who were placed on either VA or VV ECMO and received anticoagulation with either heparin or bivalirudin for at least 72 hours. The primary composite endpoint for the efficacy of bivalirudin in the use of ECMO compared to heparin was the overall incidence of thrombosis occurrences including venous and arterial thromboembolism and/or circuit related thrombotic event occurring after anticoagulation initiation. Secondary outcomes included bleeding occurrences while on anticoagulation and ECMO and the average volume of blood products received. Data collection included patient demographics, baseline characteristics, and anticoagulant used while on ECMO. Demographic data was analyzed using descriptive statistics, categorical data was analyzed using Chi- square test, and continuous data was analyzed by Student T-test. 
 
RESULTS: A total of 78 patients were included: median age 59, 69% male, and 60% received VV ECMO. The incidence of thrombotic events was similar between heparin and bivalirudin (10.2% versus 12.5%, p = 0.754). More patients who received heparin experienced a major bleeding event compared to those who received bivalirudin (28.2% versus 2.6%, p < 0.001). Additional analysis is ongoing.
 
CONCLUSION: Patients receiving bivalirudin for systemic anticoagulation on extracorporeal membrane oxygenation did not have an increased incidence of thrombotic events and had a significantly lower incidence of major bleeding events compared to heparin.