Comparative Analysis of Thrombosis in ECPella Patients Between Bivalirudin versus Heparin Anticoagulation Strategies

Objective

To review and compare the frequency of thrombus and adverse events in patients treated with heparin or bivalirudin systemic anticoagulation strategies supported on combined venoarterial extracorporeal membrane oxygenation (VA-ECMO) and Impella support (ECPella)

Design

Retrospective observational study

Setting

Single tertiary academic medical center

Participants

Patients age >18 years who were supported by ECPella between July 2021 and April 2024

Interventions

None

Measurements and Main Results

The study population comprised 98 patients, including 29 patients treated with heparin, 35 patients treated with bivalirudin, and 34 patients treated with a combination of heparin and bivalirudin. Thirteen patients had aortic thrombus and 23 patients had deep vein thrombosis (DVT), with no difference between anticoagulation strategies. Multivariate regression suggested that age and sex were factors in the increased risk for thrombus. Twenty-five of the 29 patients treated with heparin alone died, compared to 15 of the 35 patients treated with bivalirudin. There were no significant differences in intensive care unit length of stay (LOS) (13.89 days vs 24.77 days vs 26.65 days) across the 3 anticoagulation groups. Patients with either aortic thrombosis or DVT had a longer hospital LOS compared to those without either disorder (45.09 days vs 28.12 days; p = 0.049).

Conclusions

The frequency of aortic thrombus in patients supported on ECPella is high despite therapeutic anticoagulation. Routine screening with imaging is encouraged, and embolectomy should be considered at the time of decannulation to reduce postoperative complications.