198: Low vs High aPTT-Guided Bivalirudin Anticoagulation in ECMO: Single-Center Retrospective Review of Outcomes

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Introduction: Activated partial thromboplastin time (aPTT) monitors anticoagulation effect in Bivalirudin. However, it is not validated in ECMO patients and necessitates further analysis. Methods: Retrospective, single-center investigation was conducted on 103 patients requiring ECMO between January 2020 and May 2021. Study design and inclusion criteria are outlined in figure 1A. Main study population included 60 subjects; 23 with aPTT targets <60s in the control “low aPTT” group and 37 with aPTT targets >60s in the “high aPTT” group. Primary and secondary outcomes measured are listed in figure 2. Secondary analysis was conducted on 15 and 42 patients separated from the main study population that required venoarterial (VA) and venovenous (VV)-ECMO respectively, which is outlined in figure 1B. Results: The high aPTT group spent significantly longer time on ECMO, averaging 35.7 days vs 16.7 days (p = 0.004; 95% CI [6.5-31.8]). This group was also associated with the occurrence of oxygenator failure (27% vs 4.3%; two-tailed p = 0.039). Specifically, in the VV-ECMO high aPTT group, average time spent on ECMO was significantly longer (39.4 days vs 21.2 days; p = 0.045; 95% CI [0.4-36.2]). No further associations were observed (tables 2, 3, 4). Conclusions: No relationships between aPTT targets >60s vs <60s and survival, occurrence of thrombotic, or bleeding complications were observed. aPTT targets >60s were associated with longer average ECMO time and occurrence of oxygenator failure. In VV ECMO, aPTT targets >60s were also associated with longer average ECMO time.

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