Key result
Combining multimodal and real-time monitoring optimizes anticoagulation to balance frequent bleeding and thrombosis during ECMO.
Why the study?
Because thrombosis and bleeding complications are common during ECMO, closely monitoring anticoagulation is imperative to guide active drug titration and prevent complications.
Optimal management of anticoagulation during ECMO requires a multimodal monitoring approach combining conventional laboratory assays, point-of-care viscoelastic testing, and emerging real-time bedside sensors to balance the high competing risks of circuit thrombosis and patient hemorrhage.
Answers are grounded in this paper and cite their sources.
Multimodal monitoring may help balance ECMO bleeding and thrombosis risks; leaves open prospective validation of real-time techniques.
Extracorporeal membrane oxygenation (ECMO) as a modality of life support is being increasingly utilized as a bridge to recovery in patients requiring respiratory and/or cardiac support.Being highly invasive and associated with extracorporeal circulation of blood, a number of complications can arise during ECMO.The most notable among these complications are the ones related to thrombosis and bleeding.Use of a variety of anticoagulants makes it imperative to closely monitor the effect of these medications on the hemostatic milieu of the patient.Guided by the active monitoring of coagulation parameters, continuous active titration of anticoagulation is a necessity to prevent aforementioned complications.Apart from the effect of anticoagulation, patients on ECMO are intrinsically extremely ill with derangements in their physiological parameters, and existence of coagulopathy.To prevent thrombosis in the extracorporeal circuit, it is mandatory to provide some form of anticoagulation.A plethora of drugs with different modes of action are available to achieve this aim.The commonest and the oldest still being heparin, newer anticoagulants include direct thrombin inhibitors, factor Xa inhibitors, direct oral anticoagulants, Xabans, factor-XIIa inhibitors, etc.There is a wide variety of tests of coagulation which include the standard laboratory-based assays like activated partial thromboplastin time (aPTT), anti-factor Xa assay, prothrombin time/international normalized ratio, etc., to point-of-care tests like activated clotting time (ACT), and viscoelastic tests (ROTEM/TEG) are available.Newer real-time continuous monitoring tests for early detection of thrombosis are being developed actively with the aim of providing accurate bedside information which can aid in titration of anticoagulation.
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Sachdev et al. (2025) conducted a review in Critically ill patients requiring respiratory and/or cardiac support via extracorporeal membrane oxygenation (ECMO). Anticoagulation monitoring methods (laboratory-based assays, point-of-care tests, and real-time optical, acoustic, electrical, and fluorescent monitoring techniques) was evaluated. Anticoagulation monitoring during ECMO requires combining traditional assays with emerging real-time techniques to balance bleeding and thrombosis.
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