Key result
This narrative review highlights the ongoing debate regarding optimal anticoagulation strategies, agents, and monitoring tools for patients on extracorporeal membrane oxygenation.
Why the study?
Patients on ECMO remain at high risk of bleeding and thrombosis, and questions persist regarding the optimal anticoagulation strategy, monitoring tools, and management of complications.
What is the optimal anticoagulation strategy and monitoring approach for critically ill patients on ECMO?
What is the optimal anticoagulation strategy and monitoring approach for critically ill patients on ECMO?
This review highlights the complexities of anticoagulation management in ECMO patients and the lack of consensus on the optimal agent and monitoring strategy.
Optimal anticoagulation strategy for ECMO remains undefined; leaves open the need for prospective trials to guide practice.
Extracorporeal Membrane Oxygenation (ECMO) is a technology that offers organ support for critically ill patients with respiratory and/or cardiac failure. Despite improvements in recent years in technology and the biocompatibility of circuits, patients on ECMO remain at high risk of hematologic complications, such as bleeding or thrombosis. Anticoagulation is required in most cases to limit the risk of clotting, but questions persist regarding the optimal anticoagulation strategy. More precisely, there is still debate around the best anticoagulation agent and monitoring tools as well as on the transfusion thresholds and appropriate corrective measures when faced with complications. This narrative review provides an overview of hemostasis on ECMO and the impact of circuit size and coating. The benefits and downsides of unfractionated heparin (UHF) and Direct Thrombin Inhibitors (DTIs) as anticoagulation agents are reviewed. Finally, commonly available coagulation tests (activated clotting time, activated partial thrombin time, anti-Xa, and viscoelastic tests) and their limitations are addressed. In conclusion, future research is needed to determine the best anticoagulation strategy for patients on ECMO.
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Priest et al. (2024) conducted a review in Critically ill patients with respiratory and/or cardiac failure on ECMO. Anticoagulation (unfractionated heparin and Direct Thrombin Inhibitors) was evaluated. This narrative review highlights the ongoing debate regarding optimal anticoagulation strategies, agents, and monitoring tools for patients on extracorporeal membrane oxygenation.
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