Abstract Rationale The most common complications of venovenous extracorporeal membrane oxygenation (VV ECMO) are bleeding and thrombosis. Therapeutic anticoagulation is typically administered to prevent circuit thrombosis although there is evidence to suggest similar outcomes and fewer bleeding complications when anticoagulation is limited or withheld. Prior studies have been limited by small sample size, restricted to pediatric populations, or assess a different ECMO modality. Methods We retrospectively collected data for adult patients who underwent VV ECMO at our institution between March, 2016 and August, 2024. Participants were excluded if duration of ECMO run was less than 24 hours, if there was a transition to venoarterial ECMO, or if the patient presented as a polytrauma. Coagulation labs collected closest to 5 am each morning were analyzed as subtherapeutic, therapeutic, or supratherapeutic. Patients with coagulation labs subtherapeutic 76-100 percent of the time were classified as no or minimal anticoagulation. ResultsThere was no statistically significant difference in number of major hemorrhagic events 1.57 vs 1.61 p = 0.94, arterial thrombotic events 0.048 vs 0.11 p = 0.28, venous thrombotic events 0.62 vs 0.88 p = 0.20, or total blood products transfused 7.14 vs 5.90 units p = 0.59 between patients on no or minimal anticoagulation n = 21 and on standard anticoagulation n = 128 (Table 1). There were fewer circuit exchanges for patients on no or minimal anticoagulation when compared to standard anticoagulation1.14 vs 1.44 p = 0.006. 71.40 percent of patients on no or minimal anticoagulation survived to ECMO decannulation compared to 65.89 percent on standard anticoagulation p = 0.62. Conclusions There were similar rates of bleeding and thrombotic complications for patients on no or minimal anticoagulation when compared to standard anticoagulation. This study is limited due to retrospective nature and potentially unequal bleeding and thrombotic propensity between the groups. Additional evaluation, ideally with a randomized controlled trial, is needed to further assess the relationship between anticoagulation and these complications. This abstract is funded by: None
Doerr et al. (Fri,) studied this question.