Analysis of the feasibility of a low-anticoagulation strategy in patients undergoing post-cardiotomy extracorporeal membrane oxygenation: a retrospective cohort study.

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.