AI Insight
This commentary challenges the long-standing practice of targeting an activated partial thromboplastin time (aPTT) of 2.0-2.5 times baseline during extracorporeal membrane oxygenation (ECMO). The current anticoagulation targets were adopted from non-ECMO populations and incorporated into clinical guidelines without prospective validation through adequately powered trials in ECMO patients. Observational evidence is increasingly questioning whether these anticoagulation intensity targets are optimal, given that bleeding and thrombotic complications remain major sources of morbidity and mortality in ECMO patients.
Why it matters
Reassessing anticoagulation protocols during ECMO could potentially reduce serious complications including both bleeding and clotting events, which are currently major drivers of poor outcomes in critically ill patients requiring this life-support technology. Evidence-based refinement of these protocols may improve survival and reduce harm in this vulnerable patient population.
Understand the Science
Extracorporeal membrane oxygenation (ECMO) is an established therapy for refractory respiratory or circulatory failure,1 yet bleeding and thrombotic complications continue to drive much of the residual morbidity and mortality.2 Clinicians have long targeted an activated partial thromboplastin time (aPTT) of 2·0–2·5 times baseline during ECMO, a range borrowed from non-ECMO populations and written into guidelines without prospective validation in adequately powered trials.3 Observational evidence has progressively challenged this paradigm.
Source: [Comment] Rethinking anticoagulation intensity during extracorporeal membrane oxygenation