INTRODUCTION

Unfractionated heparin (UFH) is the most commonly used anticoagulant during extracorporeal membrane oxygenation (ECMO) (1). However, UFH also has several
limitations: (i) it requires individualized dosing and close monitoring, (ii) its action depends on antithrombin (AT) levels, which may be reduced in some patients, (iii) it binds to several proteins, including acute-phase reactants, making it difficult to achieve adequate dosing in patients with hyperinflammatory conditions, and (iv) it carries a risk of heparin-induced thrombocytopenia (HIT), type II (2). Direct thrombin inhibitors (DTIs), including argatroban and bivalirudin, may overcome some limitations of UFH while providing similar or greater efficacy. However, the evidence for the use of DTIs in ECMO comes mainly from retrospective
studies, which warrants conduct of prospective, randomized trials.