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Anticoagulation and Hemostasis Flashcards

7 cards from real ECMO practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

Read the first 7 Anticoagulation and Hemostasis flashcards as text

  1. Which coagulation factor is most significantly consumed during ECMO due to continuous contact with the circuit surface?

    Answer: Fibrinogen

    Fibrinogen is rapidly consumed during ECMO due to adsorption onto circuit surfaces and ongoing fibrinolysis, making it a critical monitoring parameter.

  2. A patient on ECMO has an ACT of 280 seconds and develops a new intracranial hemorrhage. What is the most appropriate immediate anticoagulation management?

    Answer: Discontinue heparin entirely and monitor closely

    Life-threatening intracranial hemorrhage on ECMO typically requires complete heparin discontinuation, accepting the risk of circuit thrombosis to prevent further bleeding.

  3. What is the primary mechanism by which bivalirudin anticoagulates ECMO patients?

    Answer: Directly and reversibly inhibiting free and clot-bound thrombin

    Bivalirudin is a direct thrombin inhibitor that binds both free and fibrin-bound thrombin directly without requiring antithrombin as a cofactor.

  4. During ECMO, which laboratory test specifically assesses fibrinolytic activity and can detect hyperfibrinolysis?

    Answer: Thromboelastography (TEG) lysis index

    TEG/ROTEM provides a lysis index (LY30 or ML) that quantifies clot lysis over time, directly detecting hyperfibrinolysis in ECMO patients.

  5. A neonate on VA-ECMO has a platelet count of 65,000/μL. What is the standard transfusion threshold for neonates on ECMO?

    Answer: 100,000/μL

    Most ECMO centers maintain platelet counts above 100,000/μL in neonates due to their higher hemorrhagic risk, particularly for intracranial hemorrhage.

  6. What is the most common cause of heparin resistance in ECMO patients?

    Answer: Antithrombin III deficiency

    Antithrombin III (AT III) deficiency is the most common cause of heparin resistance in ECMO patients, as heparin requires AT III to exert its anticoagulant effect.

  7. Which hemostatic complication is uniquely associated with centrifugal pump ECMO circuits and involves destruction of von Willebrand factor multimers?

    Answer: Acquired von Willebrand syndrome

    Continuous shear stress from centrifugal pumps cleaves high-molecular-weight von Willebrand factor multimers, causing acquired von Willebrand syndrome and mucocutaneous bleeding.