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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. What pattern on ROTEM/TEG is most consistent with acquired hypofibrinogenemia in an ECMO patient?

    Answer: Normal clotting time with significantly reduced maximum clot firmness on FIBTEM

    FIBTEM (which inhibits platelet contribution) showing reduced maximum clot firmness specifically indicates fibrinogen deficiency as the cause of impaired clot strength.

  2. A pediatric ECMO patient on heparin develops catheter-site bleeding with an ACT of 190 seconds and platelet count of 110,000/μL. What additional test helps identify platelet dysfunction as a contributor?

    Answer: Platelet function assay (PFA-100) or TEG platelet mapping

    Platelet function assays or TEG platelet mapping can identify acquired platelet dysfunction from ECMO circuit exposure even when platelet count appears adequate.

  3. What is the theoretical advantage of using heparin-bonded ECMO circuits regarding anticoagulation management?

    Answer: They reduce circuit thrombogenicity, potentially allowing lower systemic heparin doses

    Heparin-bonded circuits reduce surface thrombogenicity, allowing some programs to use lower systemic heparin doses or, in select stable patients, brief anticoagulation-free periods.

  4. In ECMO patients with both active bleeding and circuit clot, which viscoelastic TEG parameter guides the decision to use antifibrinolytic therapy?

    Answer: LY30 (percent lysis at 30 minutes)

    LY30 greater than 3% on TEG indicates significant fibrinolysis, guiding use of antifibrinolytics like tranexamic acid to reduce ongoing clot dissolution and bleeding.

  5. Which factor most significantly increases thrombin generation on ECMO beyond the circuit surface itself?

    Answer: Systemic inflammatory response activating the extrinsic coagulation pathway

    ECMO triggers a systemic inflammatory response that activates tissue factor expression on monocytes and endothelium, driving extrinsic pathway thrombin generation beyond circuit contact activation alone.

  6. An ECMO patient's ACT is 350 seconds, well above the target of 180–220 seconds. Which reversal agent can partially reduce heparin effect while continuing the circuit?

    Answer: Protamine sulfate at a reduced neutralizing dose

    Low-dose protamine (1–2 mg/kg) can partially reverse heparin over-anticoagulation without full reversal, allowing ACT to be brought into therapeutic range while continuing ECMO.

  7. What hemostatic change occurs specifically during the transition from VA-ECMO to VV-ECMO configuration in a recovering cardiac patient?

    Answer: Increased turbulence and shear from circuit reconfiguration may transiently worsen platelet consumption

    Circuit reconfiguration introduces turbulence and new surface contact areas, which can transiently increase platelet activation and consumption during and immediately after the transition.