ECMO Anticoagulation and Hemostasis 3

Question 1

When monitoring anticoagulation with anti-Xa levels during ECMO, what is the generally accepted therapeutic range?

Accepted Answer

0.3–0.7 IU/mL

Answer

Most ECMO centers target anti-Xa levels of 0.3–0.7 IU/mL, which correlates with adequate anticoagulation while minimizing hemorrhagic complications.

Question 2

A patient on ECMO develops heparin-induced thrombocytopenia (HIT). Which anticoagulant is preferred as a replacement?

Accepted Answer

Argatroban or bivalirudin

Answer

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.

Question 3

What does the 'clot amplitude at 10 minutes' (CA10) on ROTEM primarily reflect in ECMO patients?

Accepted Answer

Platelet function and fibrin polymerization

Answer

CA10 on ROTEM reflects the combined contribution of platelet function and fibrin polymerization to clot strength at 10 minutes after clotting begins.

Question 4

During prolonged ECMO, why does thrombocytopenia commonly develop even without active bleeding?

Accepted Answer

Platelets are consumed by circuit surface activation and microthrombi

Answer

Continuous platelet activation and adherence to circuit surfaces, along with microthrombus formation, consumes platelets faster than production can compensate.

Question 5

An adult VA-ECMO patient has a fibrinogen level of 98 mg/dL with ongoing oozing from cannula sites. What is the appropriate intervention?

Accepted Answer

Transfuse cryoprecipitate or fibrinogen concentrate

Answer

Cryoprecipitate or fibrinogen concentrate is the most efficient way to correct hypofibrinogenemia; fibrinogen levels below 150 mg/dL with bleeding warrant replacement.

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO - Extracorporeal Membrane Oxygenation Practice Test

ECMO Anticoagulation and Hemostasis 3