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Anticoagulation Strategies in Adults Undergoing Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis

Abstract Background Extracorporeal membrane oxygenation (ECMO) is a life-saving intervention for patients with severe cardiac or respiratory failure, but it is associated with a high risk of thrombotic and bleeding..

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Clinical Outcomes of Different Heparin Anticoagulation Monitoring Targets in Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-analysis

Abstract Objectives This systematic review and meta-analysis aimed to evaluate clinical outcomes associated with different systemic heparin protocols (conservative v standard intensity) during extracorporeal membrane oxygenation (ECMO) support. Included studies comprised both..

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2026 American Association for Thoracic Surgery Expert Consensus Document: Diagnosis and management of heparin-induced thrombocytopenia in patients who undergo cardiac…

Abstract Background Heparin-induced thrombocytopenia (HIT) in patients who undergo cardiac surgery presents unique diagnostic and management challenges due to universal perioperative heparin exposure, postoperative platelet kinetics, and the high prevalence..

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Association between platelet indices and next-day bleeding and clotting in children and adults on extracorporeal membrane oxygenation: A retrospective study

Abstract Introduction Bleeding and clotting phenotypes are common in patients supported with Extracorporeal Membrane Oxygenation (ECMO) and are associated with increased mortality. However, tools to distinguish bleeding from clotting phenotypes..

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Cumulative exposure to factor XIII deficiency during veno-arterial extracorporeal membrane oxygenation: a prospective cohort study

Abstract Factor XIII (FXIII) contributes to clot stability and reduces clot susceptibility to lysis through fibrin cross-linking. Standard coagulation tests like prothrombin time and activated partial thromboplastin time do not..

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Monitoring Hemostatic Function During Extracorporeal Membrane Oxygenation with Point-of-Care Viscoelastic Assays: A Narrative Review

Abstract Extracorporeal membrane oxygenation (ECMO) has increasingly been used in patients with refractory severe cardiorespiratory failure in recent years. The use of ECMO necessitates anticoagulation as blood passes through an..

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Minimal intraoperative anticoagulation strategy for lung transplantation with preoperative heparin-induced thrombocytopenia

Abstract Heparin-induced thrombocytopenia (HIT) in patients on mechanical circulatory support (MCS) prior to lung transplantation poses a unique challenge of balancing thrombotic versus hemorrhagic complications. An alternative method of anticoagulation..

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Biomechanical anticoagulation by spherical platelets in extracorporeal systems

Abstract Extracorporeal life support, such as hemodialysis, often face the risk of blood coagulation, where systemic anticoagulation with heparin is routinely administered. However, this strategy is contraindicated in patients at..

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Factor XII in Thrombosis and Thromboinflammation: From Molecular Biology to Clinical Translation

Abstract Factor XII (FXII) is a central mediator at the intersection of coagulation, fibrinolysis, inflammation, and immunity. It is activated upon contact with negatively charged surfaces, triggering the intrinsic coagulation..

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Intravenous Dabigatran for Anticoagulation during Cardiopulmonary Bypass in a Sheep Model

Abstract Background: Heparin is the standard anticoagulant used during cardiopulmonary bypass (CPB). However, there are problems with heparin, including immunogenicity and variability of effect, that make a search for an..

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The Year in Coagulation and Transfusion: Selected Highlights

Abstract The past year has yielded important advances in coagulation and transfusion practice across cardiothoracic and vascular care. Patient blood management remains central, with growing evidence supporting restrictive transfusion thresholds,..

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Revisiting the Concept of DIC: A Phenotype-guided Framework for Modern Hemostatic Medicine

Abstract Disseminated intravascular coagulation (DIC) has long been described as a catastrophic systemic activation of coagulation with suppressed anticoagulant and fibrinolytic pathways, culminating in macro- and microvascular thrombosis, hypoperfusion, and..

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Anticoagulants beyond coagulation: a narrative review of cardiovascular effects

Abstract Anticoagulants are widely used to prevent and treat thrombotic disorders, and continuous advances have refined their efficacy and safety. Beyond their established anticoagulant function, growing evidence indicates that some..

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Viscoelastic point-of-care testing for monitoring unfractionated heparin in critically ill patients: a prospective observational study comparing ClotPro® IN/HI-Test, aPTT and…

Abstract Background Monitoring of unfractionated heparin (UFH) in critically ill patients is challenging due to disease-related alterations of the coagulation system, directly affecting conventional laboratory tests, including activated partial thromboplastin..

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Real-Time Individualization of UFH Dosing in Cardiac Procedures: Development and Validation of an Online ACT-Based Target-Controlled Tool

Abstract Objectives To develop and validate, a real-time algorithm to individualize unfractionated heparin (UFH) dosing based on activated clotting time (ACT) dynamics in cardiac procedures with or without cardiopulmonary bypass..

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Bivalirudin Monitoring Using Dilute Thrombin Time in Pediatric Extracorporeal Membrane Oxygenation: Single-Center, Retrospective Cost Analysis, 2018–2023

Abstract Objectives:  The parenteral anticoagulant bivalirudin has favorable safety and efficacy outcomes compared with unfractionated heparin (UFH) in pediatric patients requiring extracorporeal membrane oxygenation (ECMO), and is frequently monitored using..

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Evaluation of bivalirudin-based anticoagulation for extracorporeal membrane oxygenation, including patients with COVID-19

Abstract Background: Although unfractionated heparin (UFH) has traditionally been used for anticoagulation during extracorporeal membrane oxygenation (ECMO), bivalirudin may be preferred due to fewer complications. A prior medication use evaluation..

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Prolonged Extracorporeal Membrane Oxygenation Without Systemic Anticoagulation in Sheep

Abstract Clinically significant bleeding is a common complication of extracorporeal membrane oxygenation (ECMO), with bleeding observed in upwards of 40% of patients. Bleeding is strongly associated with systemic anticoagulation, which..

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Contemporary Clinical Practices in Anticoagulation Management During Cardiopulmonary Bypass: A Europe-Wide Survey

Abstract Objectives Clinical practice in anticoagulation management, particularly in heparin administration, monitoring, reversal and haemostasis, is known to differ significantly. To better characterize this variability, we conducted a Europe-wide survey..

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Contemporary Clinical Practices in Anticoagulation Management During Cardiopulmonary Bypass: A Europe-Wide Survey

Abstract Objectives Clinical practice in anticoagulation management, particularly in heparin administration, monitoring, reversal and haemostasis, is known to differ significantly. To better characterize this variability, we conducted a Europe-wide survey..

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Comparison between regional citrate anticoagulation and systemic heparin anticoagulation in patients undergoing continuous renal replacement therapy and venoarterial extracorporeal membrane…

Abstract Introduction Regional citrate anticoagulation (RCA) is the recommended first-line strategy for continuous renal replacement therapy (CRRT) circuits. Acute kidney injury is common in patients undergoing venoarterial extracorporeal membrane oxygenation..

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Smart Clot: An Automated Point-of-Care Flow Assay for Quantitative Whole-Blood Platelet, Fibrin, and Thrombus Kinetics

Abstract Hemostasis depends on the coordinated interaction between platelets, coagulation factors, endothelium, and shear forces. Current point-of-care (POC) assays evaluate isolated components of haemostasis or operate under nearly static conditions,..

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Association Between Systemic Anticoagulation and Outcomes in Patients With Acute Respiratory Distress Syndrome Receiving Venovenous Extracorporeal Membrane Oxygenation: Insights From…

Abstract Objective:  To evaluate whether systemic anticoagulation therapy affects the survival of adult patients receiving venovenous extracorporeal membrane oxygenation (VV-ECMO) for acute respiratory distress syndrome (ARDS). Design:  Multicenter retrospective study...

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Advances in Heparin Reversal Agents: Design Strategies, Structural Features, and Pharmacological Insights

Abstract Heparin is among the most widely used anticoagulants worldwide, with an annual market of ∼$4 billion. It also poses potential bleeding risks (0.5–5%), occasionally life-threatening, necessitating heparin reversal agents...

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Successful management of IgE-mediated protamine allergy in cardiac surgery: bicentric case report

Abstract Since the use of heparin reversed by protamine is the gold standard for anticoagulation during cardiopulmonary bypass (CPB), a documented allergy to protamine represents a serious challenge for cardiac..

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Combined Antithrombin and Heparin Supplementation to Blood for Restoring Heparin Responsiveness After Andexanet Alfa Exposure: An In Vitro Model

Abstract Background: Andexanet alfa, a Gla-domainless mutant factor Xa (GDXa), reverses oral FXa inhibitors but can cause severe heparin resistance during cardiopulmonary bypass (CPB). Antithrombin (AT) supplementation may mitigate this..

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Optimising protamine dosing for heparin reversal after cardiopulmonary bypass: a population pharmacokinetic–pharmacodynamic study

Abstract Background Protamine is administered to reverse unfractionated heparin (UFH) after cardiopulmonary bypass (CPB), but dosing strategies—typically based on protamine-to-heparin (P:H) ratios—vary, and the minimal effective dose remains unclear. Reversal..

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Increased Incidence of Thrombosis in Patients at Risk of Heparin-Induced Thrombocytopenia Receiving Epoprostenol for Cardiac Surgery

Abstract Objective Heparin-induced thrombocytopenia (HIT) is a serious concern in cardiac surgery, as heparin use in the at-risk patient can lead to devastating thrombosis. Management strategies for patients with confirmed..

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Acute pulmonary hypertension induced by heparin–protamine complex during thoracoabdominal aortic grafting

Abstract Background Protamine has a more difficult side-effect profile. Circulatory collapse has been reported as a result of acute pulmonary artery spasm caused by complement cascade activation by large heparin–protamine..

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Beyond Concentration: Importance of Functional and Temporal Assessment of Fibrinogen After Cardiopulmonary Bypass

Abstract Terada et al. presented an important study on the dynamic relationship between plasma fibrinogen concentration and functional clot strength after cardiopulmonary bypass (CPB). Their findings underscore the multifactorial nature of..

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