SCCM Resource Library-Do You Even Need to Anticoagulate?

Video Transcription

Video Summary

In this video, Mike Stentz, an anesthesia intensivist, discusses the controversial topic of anticoagulation during extracorporeal membrane oxygenation (ECMO). He explains that anticoagulation has been a standard practice since the beginning of ECMO, as the bypass circuit used in ECMO is highly inflammogenic and prone to clotting. However, research has shown that biocompatible circuit materials can prevent clotting and reduce the need for systemic anticoagulation. Stentz highlights a systematic review that found similar rates of thrombotic complications between anticoagulated and non-anticoagulated patients on ECMO, but a higher rate of intracranial hemorrhage in the anticoagulation group. He also discusses a study that reported a lower complication rate in non-anticoagulated patients, although they were sicker overall. Stentz concludes by stating that he anticoagulates patients with strong indications for it, but withholds anticoagulation in actively bleeding patients or those at high risk of bleeding. He suggests that more data is needed to make a definitive recommendation on anticoagulation during ECMO.

Asset Subtitle

Hematology, 2022

Asset Caption

This session will provide an evidence-based approach to the indication, use, type, and monitoring of anticoagulation in critically ill patients requiring extracorporeal life support (ECLS). Speakers will discuss relevant controversies of the various treatment options.

Meta Tag

Content Type Presentation

Knowledge Area Hematology

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Tag Anticoagulation

Year 2022

Keywords

anticoagulation

extracorporeal membrane oxygenation

bypass circuit

thrombotic complications

intracranial hemorrhage

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