Objective: To systematically evaluate the efficacy and safety of bivalirudin and heparin for anticoagulation in extracorporeal membrane oxygenation (ECMO) in children and adolescents. Methods: PubMed

the Cochrane Library

EMBase

Wanfang

CNKI and VIP databases were retrieved for collecting clinical studies of bivalirudin and heparin for anticoagulation in ECMO in children and adolescents. The retrieval time was from the establishment of the database to Sept. 5th

2022. Two researchers independently screened literature

extracted data

and assessed the quality of included studies through the Newcastle-Ottawa Scale (NOS)

and Meta-analysis was performed through Rev Man 5. 4 software. Results: Six retrospective cohort studies including 246 patients were enrolled. Metaanalysis results indicated that compared with heparin

bivalirudin significantly reduced bleeding events (RR=0. 30

95% CI from 0. 15 to 0. 64

P =0. 002) and stroke rates (RR=0. 39

95% CI from 0. 18 to 0. 84

P =0. 02) in children and adolescents undergoing ECMO for anticoagulation

yet there were no statistically significant differences in mortality rate (RR = 0. 95

95% CI from 0. 70 to 1. 28)

incidence of thrombosis (RR=0. 94

95% CI from 0. 34 to 2. 61)

circuit intervention rate of ECMO (RR=1. 08

95% CI from 0. 53 to 2. 19)

and survival rate (RR=1. 16

95% CI from 0. 90 to 1. 49). Conclusion: Bivalirudin significantly reduces bleeding events and stroke rates in children and adolescents undergoing ECMO

yet the advantages in improving mortality rate

incidence of thrombosis

circuit intervention rate of ECMO and survival rate are not evident. As the included studies were retrospective cohort studies

the evidence level of the Meta-analysis is relatively low

inevitably leading to heterogeneity. Further high-quality randomized double-blind controlled studies are urgently needed for validation.