PEDS16: Use of Argatroban in Pediatric Patients Supported by Ventricular Assist Devices

Purpose: The use of direct thrombin inhibitors (DTI) has been associated with decreased rates of stroke and improved survival outcomes in pediatric patients supported on ventricular assist devices (VADs). The majority of information about DTI use for children on VADs has focused on bivalirudin with little to no data on argatroban. We hypothesized that, compared to use of heparin (UFH), use of argatroban would be associated with fewer bleeding, neurological and stroke events with improved survival to transplant or hospital discharge in children supported with VADs. Methods: We retrospectively collected data from patients ≤18 years old on paracorporeal continuous or paracorporeal pulsatile VAD support at Children’s Wisconsin between January 1, 2010 and July 1, 2021. Patients were divided into two cohorts based on anticoagulation strategy. We excluded those who were not primarily anticoagulated with heparin or argatroban. Definitions of bleeding, neurological, and stroke events were the same as in other published reports on this population. Categorical variables were compared with the Chi square test or Fisher’s exact test, continuous variables with the Mann-Whitney test. Results: Twenty children were anticoagulated with argatroban and sixteen with heparin. We found no statistical difference between the anticoagulant groups when comparing baseline demographic data, but both groups were highly complex with a majority of patients having underlying congenital heart disease and need for ECMO support prior to VAD implantation (Table 1). There was no statistical difference between groups regarding bleeding, neurological, or stroke events, nor was there a difference regarding survival outcomes (Table 2). Conclusion: Our single center study of children on VAD support found no difference in incidence of stroke, major bleeding, or death between patients treated with UFH and those treated with argatroban. Multiple other factors including complexity of the study population with a high rate of ECMO use prior to VAD support likely impacted our findings. Our study ultimately does not support argatroban as an improved alternative anticoagulant compared to UFH in children requiring VADs.