Background

Extracorporeal membrane oxygenation (ECMO) is increasingly used in patients after cardiac surgery; however, anticoagulation management has consistently been challenging. This study aimed to explore the feasibility of a low-anticoagulation strategy for post-cardiotomy ECMO (PC-ECMO).

Methods

A retrospective comparison was performed between two anticoagulation targets in adult patients undergoing veno-arterial ECMO after cardiac surgery at the Beijing Anzhen Hospital (Beijing, China) between January 2018 and November 2023. The low-anticoagulation (LAC) strategy group consisted of patients with an activated partial thromboplastin time (APTT) ratio of 1–1.5, whereas the conventional anticoagulation (CAC) strategy group included those with an APTT ratio of 1.5–2.5. The primary outcome was thrombotic complications associated with ECMO. Secondary outcomes included bleeding events, pulmonary infection, need for renal replacement therapy, in-hospital mortality rate, ECMO support duration, hours of mechanical ventilation, anticoagulation fraction, length of hospitalization, and transfusion volume(s).

Results

The study included data from 203 patients, who were divided into two groups: LAC (n = 108 [53.2%]) and CAC (n = 95 [46.8%]). Propensity score matching was used to balance confounding variables. A total of 43 patient pairs were successfully matched, and no significant difference was observed in thrombotic complications between the LAC and CAC groups (30.2% versus [vs.] 25.3%, respectively; p = 0.810). Meanwhile, no significant differences were observed in secondary outcomes and subgroups within the matched cohort, except for ECMO support time, which was shorter in the LAC group (119.6 h vs. 146.0 h; p = 0.015).

Conclusion

The low-anticoagulation strategy was feasible for PC-ECMO support.