82: Argatroban is a Safe and Effective Anti-Thrombotic Agent in VA-ECMO: The Piedmont Experience

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Introduction: In patients cannulated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO), use of anti-thrombotic agents is critical to prevent complications. Unfractionated heparin (UFH) is the most used agent, however its response is unpredictable and has complications including heparin resistance and heparin induced thrombocytopenia. Direct thrombin inhibitors are an attractive alternative to UFH. Here we present our single center experience with argatroban (our institution’s first line anti-thrombotic agent) examining bleeding complications, thrombotic complications, and patient outcomes. Methods: We included all adults supported on VA-ECMO in our institution from 2011–2024 and received argatroban for anticoagulation. The primary outcomes of interest were thrombotic complications (membrane thrombosis, circuit thrombosis, ischemic stroke, and limb ischemia), bleeding complications (intracerebral hemorrhage, gastrointestinal bleeding, surgical site bleeding), and survival to hospital discharge. Analysis was performed using R (V4.4.2). Results: A total of 1044 patients met inclusion criteria, with a median age of 58 [IQR: 46-68] years, BMI 30.4 [26.1-35.6] kg/m2, and 36% (373/1044) female. Regarding the primary outcomes, 201 (19%) experienced any bleeding, 118 (11.3%) experienced any thrombosis and 576 (55.2%) survived to hospital discharge (see table for details). Conclusion: In our single center experience using argatroban as the first line anti-thrombotic agent in patients supported on VA-ECMO, bleeding and thrombotic complications were comparable to national registry data.

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