The study focuses on comparing argatroban with unfractionated heparin (UFH) as anticoagulants for COVID-19 patients undergoing veno-venous extracorporeal membrane oxygenation (VV-ECMO). Heparin-induced thrombocytopenia (HIT) is a common complication of heparin use, characterized by a drop in platelet count. This retrospective analysis evaluates argatroban’s safety and efficacy, particularly for patients who develop HIT during ECMO support. Forty patients were included, with 19 completing ECMO therapy on UFH and 21 switching to argatroban due to significant thrombocytopenia.
The primary aim was to compare bleeding rates between the two groups. Results showed a significantly lower incidence of bleeding in the argatroban group (21 events over 357 ECMO days) compared to the UFH group (58 events over 579 ECMO days). Tracheal stoma bleeding was notably reduced with argatroban (1 vs. 14 events). Platelet count preservation was another key finding, with argatroban-treated patients demonstrating a smaller median platelet drop over five days compared to those on UFH.
Secondary analyses revealed no major thrombotic events in either group, confirming the effectiveness of both anticoagulants in preventing clots during ECMO. However, argatroban’s protective effect on platelet counts suggests it may offer additional benefits in patients with low baseline platelet levels or those at high risk of bleeding. Despite argatroban’s higher cost and limited availability compared to UFH, its use may reduce the need for blood product transfusions and oxygenator replacements during ECMO.
The study concludes that argatroban is a safe and effective alternative for anticoagulation in VV-ECMO, particularly for patients with HIT or significant thrombocytopenia. Further randomized controlled trials are recommended to confirm these findings and optimize anticoagulation protocols for ECMO patients.
