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Our study sought to investigate the efficacy and safety of bivalirudin versus those of unfractionated heparin (UFH) in patients undergoing extracorporeal membrane oxygenation (ECMO).PubMed, EMBASE and Cochrane Library were searched for studies enrolling ECMO patients on bivalirudin and UFH (from inception till July 2021). Meta-analysis was conducted. The IFourteen eligible retrospective observational studies with 1501 subjects were identified. Compared with UFH, bivalirudin significantly reduced the risk of in-circuit thrombosis (OR = 0.44, 95% CI [0.31-0.61], p = 0.000), thrombosis (OR = 0.61, 95% CI [0.45-0.83], p= 0.002) and hospital mortality (OR = 0.78, 95% CI [0.61-0.99], p = 0.04) and had a positive impact on survival ECMO (OR = 1.50, 95% CI [1.04-2.16], p= 0.032). Decrease in risk of bleeding (OR = 0.36, 95% CI [0.14-0.91], p = 0.031) associated with bivalirudin was observed. Sources of heterogeneity were identified, and sensitivity analysis revealed similar results.Our meta-analysis suggested that bivalirudin was associated with the decreased risk of in-circuit thrombosis, thrombosis, hospital mortality and bleeding in patients on ECMO and improved survival ECMO, indicating the superiority of bivalirudin to UFH in terms of efficacy and safety. |
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