ReviewCritical care (London, England)2020
Clinical controversies in anticoagulation monitoring and antithrombin supplementation for ECMO.
Review in Critical care (London, England), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04997265 (Strategies for Anticoagulation During Venovenous ECMO), which is not on this map. Cited by 87 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Strategies for Anticoagulation During Venovenous ECMO: The SAFE-ECMO Pilot Trial
Who cites it
87 citing papers in PubMed, 4 syntheses or guidelines pooled it, 197 citations in OpenAlex.
- Association of anti-factor Xa-guided anticoagulation with hemorrhage during ECMO support: A systematic review and meta-analysis.Clinical cardiology · 2024Pooled it
- Anti-Xa versus time-guided anticoagulation strategies in extracorporeal membrane oxygenation: a systematic review and meta-analysis.Perfusion · 2021Pooled it
- Guideline
- ISTH DIC subcommittee communication on anticoagulation in COVID-19.Journal of thrombosis and haemostasis : JTH · 2020Guideline
- Trial
- Development and validation of a deep learning model to predict heparin response in critically ill patients with deep vein thrombosis receiving continuous intravenous heparin infusion.Blood science (Baltimore, Md.) · 2026Article
- Real-world outcomes of unfractionated heparin plus antithrombin concentrate versus bivalirudin in adult patients undergoing extracorporeal membrane oxygenation.The journal of extra-corporeal technology · 2026Article
- Biomechanical anticoagulation by spherical platelets in extracorporeal systems.Proceedings of the National Academy of Sciences of the United States of America · 2026Article
- Management of Amniotic Fluid Embolism (AFE) using anticoagulation-free ECMO.Zeitschrift fur Geburtshilfe und Neonatologie · 2026Article
- Development and internal validation of an interpretable machine learning model to predict coagulopathy following extracorporeal membrane oxygenation: a retrospective multicenter study.Scandinavian journal of trauma, resuscitation and emergency medicine · 2026Article
- Monitoring unfractionated heparin in ECMO and cardiac surgery: the search for a valid reference standard.Frontiers in medicine · 2026Article
- Thromboelastography Associates to Decreased Plasma Transfusions in the Medical Intensive Care Unit: A Retrospective Study.Critical care research and practice · 2026Article
- Heparin resistance in a patient with severe acute pancreatitis: a case report.Laboratory medicine · 2025Article
- Activated Clotting Time and Haemostatic Complications in Patients Receiving ECMO Support: A Systematic Review.Journal of cardiovascular development and disease · 2025Review
- Anticoagulation during Extracorporeal Membrane Oxygenation (ECMO): A Selective Inhibitor of Activated Factor XII Compared to Heparin in anACS pharmacology & translational science · 2025Article
- Development of a Method for Visualizing and Quantifying Thrombus Formation in Extracorporeal Membrane Oxygenators.Cellular and molecular bioengineering · 2025Article
- Decreased bleeding and thrombotic complications on extracorporeal membrane oxygenation support following an updated anticoagulation protocol.JTCVS open · 2025Article
- Vascular Complications After Venoarterial Extracorporeal Membrane Oxygenation Support: A CT Study.Critical care medicine · 2025Observational
- Is Antithrombin Supplementation Effective in Suppressing ECMO Circuit Thrombosis in Sepsis?Juntendo medical journal · 2025Review
- Pharmacokinetic and pharmacodynamic analyses of nafamostat in ECMO patients: comparing central vein and ECMO machine samples.Frontiers in pharmacology · 2025Article
27 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
Authors and funding
5 authors at 5 institutions in 1 country.
Funding
Abstract
During extracorporeal membrane oxygenation (ECMO), a delicate balance is required to titrate systemic anticoagulation to prevent thrombotic complications within the circuit and prevent bleeding in the patient. Despite focused efforts to achieve this balance, the frequency of both thrombotic and bleeding events remains high. Anticoagulation is complicated to manage in this population due to the complexities of the hemostatic system that are compounded by age-related developmental hemostatic changes, variable effects of the etiology of critical illness on hemostasis, and blood-circuit interaction. Lack of high-quality data to guide anticoagulation management in ECMO patients results in marked practice variability among centers. One aspect of anticoagulation therapy that is particularly challenging is the use of antithrombin (AT) supplementation for heparin resistance. This is especially controversial in the neonatal and pediatric population due to the baseline higher risk of bleeding in this cohort. The indication for AT supplementation is further compounded by the potential inaccuracy of the diagnosis of heparin resistance based on the standard laboratory parameters used to assess heparin effect. With concerns regarding the adverse impact of bleeding and thrombosis, clinicians and institutions are faced with making difficult, real-time decisions aimed at optimizing anticoagulation in this setting. In this clinically focused review, the authors discuss the complexities of anticoagulation monitoring and therapeutic intervention for patients on ECMO and examine the challenges surrounding AT supplementation given both the historical and current perspectives summarized in the literature on these topics.
Indexed as
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.