ECMO Without Anticoagulation:

  • In some special cases, patients can be on ECMO for a prolonged period without any anticoagulation.
  • This is not ideal, but is sometimes necessary for patients in whom bleeding would be catastrophic and life threatening.
  • Patients on VA ECMO are at much higher risk for complications because clots can be embolized directly into the arterial circulation.
  • While it may be necessary to stop heparin in the case of bleeding, definitive management of the bleeding should be sought as soon as possible so that heparin can be restarted.

Next page: Anticoagulation: ROTEM

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