Predictive Factors of Coagulopathy in Patients Undergoing ECMO in a Tertiary Care Center: An Observational Prospective Study

Background: Coagulopathy is a prevalent and life-threatening complication in patients undergoing extracorporeal membrane oxygenation (ECMO), often resulting from the interplay of systemic inflammation, hemodilution, and circuit-induced coagulopathy.This study aimed to identify the predictive factors of coagulopathy in patients undergoing ECMO using thromboelastography (TEG) and correlate these factors with conventional coagulation and inflammatory markers.Materials and methods: This prospective observational study was conducted in the ECMO intensive care unit of MGM Healthcare, Chennai, Tamil Nadu, India, between January 2024 and March 2025.Ten patients, including both adults and children, who were initiated on ECMO (venovenous or venoarterial, central or peripheral), were enrolled using continuous sampling.Patients on extracorporeal interval support for organ retrieval were excluded.Daily laboratory parameters, including platelet count, prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), fibrinogen, D-dimer, and procalcitonin levels, were recorded along with TEG parameters [reaction time (R), kinetics or clot formation time (K) angle, maximum amplitude (MA), clot firmness (G), estimated percent lysis (EPL%)].Coagulopathy was defined as a platelet count <1,00,000/mm 3 or a PT > 20 seconds.Results: Among the included patients, the mean platelet count decreased significantly over time, and coagulopathy was observed in >90% of the cases.Thromboelastography parameters were as follows: R time, 13.2 ± 12.09 minutes; K time, 7.48 ± 4.83 minutes; angle, 52.8 ± 70.2°; MA, 47.0 ± 13.4 mm; G, 6.3 ± 3.6 d/sec; and EPL%, 24.5 ± 35.0%.Maximum amplitude < 50 mm and EPL > 15% were strong predictors of coagulopathy in this study.Procalcitonin and EPL% showed a perfect negative correlation (r = -1.00,p < 0.0001).International normalized ratio and G were positively correlated (r = 0.87, p < 0.0001), whereas K time and MA were inversely correlated (r = -0.66,p < 0.0001).Conclusion: Patients undergoing ECMO frequently develop coagulopathy, characterized by delayed clot initiation, reduced clot strength, and increased fibrinolysis.Thromboelastography markers, particularly low MA and high EPL%, demonstrated strong predictive value and should be integrated into routine monitoring for the early identification and targeted management of coagulopathy.