Which anticoagulation monitoring parameter is considered suitable for managing anticoagulation therapy in ECMO patients?

In the context of managing anticoagulation therapy in patients on Extracorporeal Membrane Oxygenation (ECMO), targeting the activated Partial Thromboplastin Time (aPTT) in the high range is an established practice. Patients undergoing ECMO are at significant risk for thrombosis due to the artificial nature of the circuit and the mechanical interactions between blood and the device. This hypercoagulable state necessitates precise monitoring of anticoagulation to prevent complications such as clot formation within the ECMO circuit.

The aPTT is a commonly used test to monitor the anticoagulant effect of agents such as unfractionated heparin, which is often employed in ECMO management. Clinicians typically aim for a higher aPTT range to ensure adequate anticoagulation, taking into account the increased risk of clotting in these patients. This monitoring approach helps to titrate heparin dosing effectively and adjust for changes in therapy or patient condition.

In contrast, while other methods like anti-Xa levels (commonly used for low molecular weight heparins) and activated clotting time (ACT) can have significant roles in other settings, they are not the primary standard for ECMO patients specifically. ACT is often influenced by factors