Anticoagulation-related complicationsÂ
Unfractionated heparin is often used for anticoagulation to keep the
circulatory system patent to prevent thrombosis formation in the
extracorporeal circulation and the patient’s circulatory system.
Thankfully current ECMO circuits have almost no possibility of thrombus
formation. Haemolysis can also occur especially if a thrombus forms in
the pump causing mechanical damage to cells resulting in haemolytic
anaemia. Heparin-induced thrombocytopenia could also be a cause of clot
formation. Intracranial haemorrhage is also a possibility in ECMO
patients from excess infusion of anticoagulation and early correction of
thrombocytopenia may help reduce risks of occurrence. Other neurological
complications such as strokes and cognitive impairment could also result
if haemostatic balance is not well controlled.
D-dimers can be monitored daily to look out for any clot formation and
to anticipate eminent ECMO failure. Before ECMO initiation, patients
should be tested for any coagulation disorders by measuring parameters
such as antithrombin and fibrinogen levels, which can be corrected to
prevent further complications.