ArticleFrontiers in medicine2026
Monitoring unfractionated heparin in ECMO and cardiac surgery: the search for a valid reference standard.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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Abstract
Unfractionated heparin remains the standard anticoagulant during cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO). Despite decades of clinical use, however, no universally validated reference method exists for measuring biologically active unfractionated heparin in these settings. Conventional assays such as the activated clotting time and the activated partial thromboplastin time lack specificity and standardisation. Consequently, anti-factor Xa (anti-Xa) assays are increasingly recommended as alternative methods (or even reference methods). Nevertheless, their validity as a true reference standard in CPB and ECMO has never been formally established. This situation creates a methodological paradox: an assay with context-dependent limitations is used to calibrate and validate other imperfect tests. Anti-Xa assays differ substantially in design, particularly regarding the inclusion of dextran sulphate. Dextran sulphate was introduced to prevent
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