Bivalirudin Anticoagulation Performance in Pediatric and Neonatal Extracorporeal Membrane Oxygenation

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Extracorporeal membrane oxygenation (ECMO) is a life-sustaining support for cardiac and/or respiratory systems in critically ill patients. The exposure of blood to the large surface area of nonbiologic materials in the ECMO circuit activates the coagulation cascade, leading to a high risk of clot formation. Without anticoagulation, thrombi can obstruct the circuit, compromise oxygenation and perfusion, and cause embolic events, including stroke and organ dysfunction. Per the Extracorporeal Life Support Organization (ELSO) 2021 guidelines, unfractionated heparin (UFH) is the primary anticoagulant described for use due to its low cost, reversibility, and familiarity. However, heparin resistance and heparin-induced thrombocytopenia (HIT) are well-known complications of heparin therapy. The ELSO guidelines outline direct thrombin inhibitors (DTIs) as alternatives in these instances.

This study is a single center retrospective case series. Our objective is to characterize the dose-response relationship between continuous bivalirudin infusion rate (mg/kg/h) and contemporaneous aPTT in neonatal and pediatric patients supported with ECMO, using the current institutional aPTT-based bivalirudin titration nomogram to guide care. Secondary objectives are to broadly assess the performance of aPTT-guided bivalirudin anticoagulation by describing anticoagulation quality metrics, bleeding and thrombotic safety signals, ECMO course outcomes, and exploring relationships between patient- and circuit-level factors to inform future optimization of monitoring and dosing strategies.

In 2022, Helen DeVos Children's Hospital added bivalirudin for ECMO anticoagulation as an alternative option to heparin through an established protocol. This retrospective case series seeks to evaluate the efficacy and safety of the current bivalirudin protocol for pediatric and neonatal ECMO patients at HDVCH. The results of this study will inform evidence-based modifications to the current aPTT-guided bivalirudin nomogram, aiming to optimize both the time required to achieve therapeutic anticoagulation and proportion of time maintained within therapeutic range.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1921

This document is currently not available here.

Share

COinS