Optimizing Anticoagulation in Pediatric ECMO Patients: A Comparative Study of Bivalirudin and HeparinUsing Thromboelastography (TEG)

Abstract

At Boston Children’s Hospital (BCH), pediatric patient (≤ 18 years of age) intervention with Extracorporeal Membrane Oxygenation (ECMO) therapy presents a unique challenge in coagulation management. This thesis investigates the intricacies of coagulation management utilizing a retrospective cohort design, the study explores the efficacy of two anticoagulants, bivalirudin and heparin, in modulating thromboelastography (TEG) parameters, specifically Reaction time (R-time), Kinetic time (K-time), Alpha Angle (Angle), Maximum Amplitude (MA), in comparison to Partial Thromboplastin (PTT) Data collected from December 1st, 2015 to February 19th, 2024, encompass 363 pediatric ECMO patients. The research aims to characterize coagulation profiles, assess the predictive power of TEG in determining anticoagulation status, and develop optimized anticoagulation protocols. Specifically, prolonged R-time, extended K-time, lower Angle, and reduced MA were significantly associated with increased bleeding risks. Bivalirudin, compared to heparin, demonstrated distinct advantages in optimizing these TEG parameters, thereby suggesting greater efficacy in managing coagulation during ECMO. Multivariable logistic regression analyses underscore the critical role of specific TEG parameters in predicting bleeding events, highlighting the potential for TEG-guided anticoagulation protocols. These findings support the hypothesis that TEG can be a helpful diagnostic test for ECMO patients, shedding light on improved management strategies and reduced incidence of adverse bleeding events.