Anticoagulation strategies in extracorporeal circulatory devices in adult populations

Catherine Kato, Michael Oakes, Morris Kim, Anish Desai, Sven R. Olson, Vikram Raghunathan, Joseph J. Shatzel

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations

Abstract

Extracorporeal circulatory devices such as hemodialysis and extracorporeal membrane oxygenation can be lifesaving; however, they are also prone to pathologic events including device failure, venous and arterial thrombosis, hemorrhage, and an accelerated risk for atherosclerotic disease due to interactions between blood components and device surfaces of varying biocompatibility. While extracorporeal devices may be used acutely for limited periods of time (eg, extracorporeal membrane oxygenation, continuous venovenous hemofiltration, therapeutic apheresis), some patients require chronic use of these technologies (eg, intermittent hemodialysis and left ventricular assist devices). Given the substantial thrombotic risks associated with extracorporeal devices, multiple antiplatelet and anticoagulation strategies—including unfractionated heparin, low-molecular-weight heparin, citrate, direct thrombin inhibitors, and direct oral anticoagulants, have been used to mitigate the thrombotic milieu within the patient and device. In the following manuscript, we outline the current data on anticoagulation strategies for commonly used extracorporeal circulatory devices, highlighting the potential benefits and complications involved with each.

Original languageEnglish (US)
Pages (from-to)19-31
Number of pages13
JournalEuropean Journal of Haematology
Volume106
Issue number1
DOIs
StatePublished - Jan 2021

Keywords

  • ECMO
  • anticoagulation
  • dialysis
  • hemorrhage
  • thrombosis

ASJC Scopus subject areas

  • Hematology

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