Bivalirudin may be a safe, cost-effective alternative to heparin in achieving anticoagulation in pediatric extracorporeal membrane oxygenation (ECMO) patients. Prospective multicenter studies and randomized control trials with standard anticoagulation targets are needed to accurately compare outcomes associated with heparin versus bivalirudin in pediatric ECMO patients.

In total, 196 pediatric patients were anticoagulated with heparin and 117 were anticoagulated with bivalirudin while on ECMO.

Across the included studies, it was found that for patients treated with bivalirudin, trends were noted toward lower rates of bleeding, transfusion requirements, and thrombosis with no difference in mortality.

Overall costs associated with bivalirudin therapy were lower.

Time to therapeutic anticoagulation varied between studies though institutions had different anticoagulation targets.

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