• Marina Pieri, Luisa Quaggiotti, Evgeny Fominskiy, Giovanni Landoni, Maria Grazia Calabrò, Silvia Ajello, Matteo Aldo Bonizzoni, Alessandro Belletti, and Anna Mara Scandroglio.
• Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
• J. Cardiothorac. Vasc. Anesth. 2022 Aug 1; 36 (8 Pt B): 296129672961-2967.

ObjectivesTo compare heparin-based anticoagulation and bivalirudin-based anticoagulation within the context of critically ill patients with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.DesignAn observational study.SettingAt the intensive care unit of a university hospital.Participants And InterventionsCritically ill patients with a SARS-CoV-2 infection receiving full anticoagulation with heparin or bivalirudin.Measurements And Main ResultsTwenty-three patients received full anticoagulation with bivalirudin and 60 with heparin. Despite patients in the bivalirudin group having higher mortality risk scores (SAPS II 60 ± 16 v 39 ±7, p < 0.001) and a higher need for extracorporeal support compared to the heparin group, hospital mortality was comparable (57% v 45, p = 0.3). No difference in thromboembolic complications was observed, and bleeding events were more frequent in patients treated with bivalirudin (65% v 40%, p = 0.01). Similar results were confirmed in the subgroup analysis of patients undergoing intravenous anticoagulation; in addition to comparable thrombotic complications occurrence and thrombocytopenia rate, however, no difference in the bleeding rate was observed (65% v 35%, p = 0.08).ConclusionsAlthough heparin is the most used anticoagulant in the intensive care setting, bivalirudin-based anticoagulation was safe and effective in a cohort of critically ill patients with SARS-CoV-2. Bivalirudin may be given full consideration as an anticoagulation strategy for critically ill patients with SARS-CoV-2, especially in those with thrombocytopenia and on extracorporeal support.Copyright © 2022 Elsevier Inc. All rights reserved.

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