Pharmacology and Anticoagulation in ECMO

The healthy human body relies on many feedback mechanisms and regulatory processes for the maintenance of hemostasis, and these processes become deranged in the setting of critical illness and ECMO. Several agents are available for anticoagulation in ECMO, such as heparin, argatroban, and bivalirudin, with many different testing assays to assess their efficacy and safety. In contrast, bleeding is the most common complication of ECMO, and antifibrinolytics such as tranexamic acid and aminocaproic acid are available at a local and systemic level to treat life-threatening hemorrhage. Ultimately, the successful management of an ECMO patient relies on interdisciplinary discussion surrounding the individual patient’s risk of bleeding and clotting.