Which goal anticoagulation target is appropriate for a patient on ECMO?

In the context of patients on Extracorporeal Membrane Oxygenation (ECMO), the appropriate anticoagulation target is an anti-Xa level of 0.3 to 0.7 IU/mL. This range is established based on the need for effective anticoagulation to prevent clot formation in the circuit while minimizing the risk of bleeding complications.

When patients are on ECMO, they often have high blood flow rates and artificial surfaces that increase the risk of thrombosis. The anti-Xa assay is particularly useful in monitoring anticoagulation therapy with unfractionated heparin, as it measures the inhibition of factor Xa, which is directly involved in the coagulation cascade. Maintaining the anti-Xa level within this target range helps ensure that the patient is adequately anticoagulated to avoid clotting within the ECMO circuit.

Other anticoagulation monitoring methods, such as activated partial thromboplastin time (aPTT), activated clotting time (ACT), and thromboelastography (TEG), can also be utilized; however, they may not provide the same direct correlation to anticoagulation effect as the anti-Xa levels do in this specific setting. ECMO management typically favors anti-Xa monitoring due to