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
When monitoring anticoagulation with anti-Xa levels during ECMO, what is the generally accepted therapeutic range?
Answer: 0.3–0.7 IU/mL
Most ECMO centers target anti-Xa levels of 0.3–0.7 IU/mL, which correlates with adequate anticoagulation while minimizing hemorrhagic complications.
A patient on ECMO develops heparin-induced thrombocytopenia (HIT). Which anticoagulant is preferred as a replacement?
Answer: Argatroban or bivalirudin
Direct thrombin inhibitors such as argatroban or bivalirudin are the preferred alternatives when HIT is confirmed during ECMO, as all heparin products must be avoided.
What does the 'clot amplitude at 10 minutes' (CA10) on ROTEM primarily reflect in ECMO patients?
Answer: Platelet function and fibrin polymerization
CA10 on ROTEM reflects the combined contribution of platelet function and fibrin polymerization to clot strength at 10 minutes after clotting begins.
During prolonged ECMO, why does thrombocytopenia commonly develop even without active bleeding?
Answer: Platelets are consumed by circuit surface activation and microthrombi
Continuous platelet activation and adherence to circuit surfaces, along with microthrombus formation, consumes platelets faster than production can compensate.
An adult VA-ECMO patient has a fibrinogen level of 98 mg/dL with ongoing oozing from cannula sites. What is the appropriate intervention?
Answer: Transfuse cryoprecipitate or fibrinogen concentrate
Cryoprecipitate or fibrinogen concentrate is the most efficient way to correct hypofibrinogenemia; fibrinogen levels below 150 mg/dL with bleeding warrant replacement.
Which test best differentiates heparin resistance from disseminated intravascular coagulation (DIC) in ECMO patients?
Answer: Anti-Xa level with concurrent AT III assay
Measuring anti-Xa activity alongside AT III levels distinguishes heparin resistance (low AT III, low anti-Xa despite adequate heparin dose) from DIC (multiple factor deficiencies).
What is the significance of 'delta ACT' monitoring during ECMO circuit change-out?
Answer: It detects the ACT drop when blood contacts the new uncoated circuit surface
When blood contacts a new circuit surface, ACT drops as heparin is temporarily adsorbed and consumed, requiring a heparin bolus to re-establish therapeutic anticoagulation.