Pediatric Nephrology Fellow Children's National Hospital Washington, District of Columbia, United States
Background: Bivalirudin, a direct thrombin inhibitor, is an option for anticoagulation for patients on extracorporeal membrane oxygenation (ECMO) or with ventricular assist devices (VAD). ECMO and VAD are associated with increased risk of acute kidney injury. Anticoagulation strategies need to be adapted to include the use of bivalirudin for CRRT. Objective: We aim to evaluate circuit and patient outcomes when using bivalirudin in addition to regional citrate anticoagulation (RCA) for CRRT. We hypothesize that combination of bivalirudin and RCA will prolong CRRT circuit life with decreased clotting events. Design/Methods: The study has been approved by the IRB with waiver of informed consent and HIPAA authorization. We will perform a single center retrospective cohort study comparing the use of bivalirudin plus RCA versus RCA alone for CRRT circuit maintenance, among patients admitted to the cardiac intensive care unit between Jan 2016 and Dec 2022. Study subjects (n = 29 on RCA alone and n = 15 on RCA + bivalirudin) have been identified by institutional pharmacy prescribing records of citrate and bivalirudin, and EMR documentation. Circuit duration, and systemic bleeding and clotting events will be compared. Data collection will finish in Dec 2023 and statistical analysis will start in Jan 2024. The data will be analyzed using generalized mixed effect linear models with time autocorrelation structure within each patient to model circuit life, bleeding events, and clotting events. Because of the small patient pool, we will use one circuit as a measurement to increase the sample size. Rates of citrate toxicity will also be measured in days. ECMO or VAD outcomes, patient coagulation profiles, illness severity (measured by the Pediatric Logistic Organ Dysfunction score), morbidity, and hospital length of stay will be analyzed for differences between the two groups.
