{
  "abstract": "Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a lifesaving strategy for refractory cardiac arrest, restoring systemic perfusion when conventional cardiopulmonary resuscitation fails. However, ECPR profoundly disrupts haemostasis, driven by the combined effects of whole-body ischaemia-reperfusion injury, systemic inflammation, endothelial activation, platelet dysfunction, and blood contact with extracorporeal surfaces. Together, these processes create a highly dynamic and unstable thromboinflammatory milieu, marked by the simultaneous risk of thrombosis and life-threatening bleeding. Systemic anticoagulation is required to maintain circuit patency and prevent thromboembolic complications, yet optimal strategies remain uncertain. Haemostasis during ECPR is highly dynamic, shaped by the underlying aetiology of cardiac arrest, patient-specific characteristics, and circuit-related factors. This complexity underscores the limitations of fixed anticoagulation targets and the need for individualized, context-sensitive management guided by continuous clinical and laboratory assessment. Despite the increasing global adoption of ECPR, high-quality evidence to guide anticoagulation practices remains scarce. Current strategies are largely extrapolated from other extracorporeal life support populations, contributing to substantial inter-centre variability. This review synthesizes the available evidence on coagulopathy and anticoagulation in adult patients receiving ECPR and discusses emerging approaches to monitoring and anticoagulation management.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Anaesthesia and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, 6020, Austria. sasa.rajsic@i-med.ac.at.",
    "Department of Critical Care, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.",
    "Department of Respiratory Medicine, Paracelsus Medical University, Nuremberg, Germany.",
    "Great Ormond Street Hospital for Children, NHS Foundation Trust, University College London, London, UK.",
    "Paediatric intensive care Unit, Leiden University Medical Centre, Leiden, The Netherlands.",
    "Paediatric Intensive Care Unit, Department of Paediatrics, Queen Fabiola University Children's Hospital (University Hospital Brussels), Brussels, Belgium.",
    "Department of Anaesthesia and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, 6020, Austria.",
    "Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria.",
    "Hammersmith Hospital - Imperial College Healthcare, Imperial College University, London, UK.",
    "Guy's and St Thomas' NHS Foundation Trust, London, UK.",
    "Cardiothoracic ICU and Anaesthesia 2, Foundation IRCCS Policlinico San Matteo, Pavia, Italy.",
    "Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic.",
    "Institute for Heart Diseases, Wroclaw Medical University, Wrocław, Poland.",
    "Department of Anaesthesia and Critical Care, Royal Brompton & Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK.",
    "Division of Cancer and surgery, Faculty of Medicine, Imperial College, London, UK.",
    "Department of Cardiology and Cardiac Intensive Care, Heart Centre Aalst, Azorg Hospital, Aalst, Belgium."
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 15,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Sasa Rajsic",
      "orcid": "0000-0001-6193-3662"
    },
    {
      "affs": [
        1
      ],
      "name": "Annemieke Oude Lansink-Hartgring"
    },
    {
      "affs": [
        2
      ],
      "name": "Justyna Swol"
    },
    {
      "affs": [
        1
      ],
      "name": "Walter M van den Bergh"
    },
    {
      "affs": [
        3
      ],
      "name": "Mirjana Cvetkovic"
    },
    {
      "affs": [
        4
      ],
      "name": "Peter Paul Roeleveld"
    },
    {
      "affs": [
        5
      ],
      "name": "Ariane Willems"
    },
    {
      "affs": [
        6
      ],
      "name": "Gabriel Putzer"
    },
    {
      "affs": [
        7
      ],
      "name": "Nina Buchtele"
    },
    {
      "affs": [
        8
      ],
      "name": "Louit Thakuria"
    },
    {
      "affs": [
        9
      ],
      "name": "Waqas Akhtar"
    },
    {
      "affs": [
        9
      ],
      "name": "Alex Rosenberg"
    },
    {
      "affs": [
        10
      ],
      "name": "Mirko Belliato"
    },
    {
      "affs": [
        11,
        12
      ],
      "name": "Jan Bělohlávek"
    },
    {
      "affs": [
        13,
        14,
        15
      ],
      "name": "Christophe Vandenbriele"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4dncjxhn4cg8x.bib",
  "cited_by": 0,
  "doi": "10.1186/s13054-026-06204-5",
  "fulltext_url": "https://europepmc.org/articles/PMC13726209",
  "id": "4dncjxhn4cg8x",
  "issns": [
    "1364-8535",
    "1466-609X"
  ],
  "landing_url": "https://europepmc.org/article/MED/42972582",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Review"
    ],
    [
      "openalex",
      "2204|Mechanical Circulatory Support Devices"
    ]
  ],
  "openalex": "W7172125605",
  "pdf_url": "https://europepmc.org/articles/PMC13726209?pdf=render",
  "pmcid": "PMC13726209",
  "pmid": "42972582",
  "published": "2026-08-01",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/4dncjxhn4cg8x.ris",
  "sources": [
    {
      "first_seen": "2026-11-04T15:20:45Z",
      "native_id": "MED:42972582",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42972582"
    },
    {
      "first_seen": "2026-11-05T12:22:36Z",
      "native_id": "PMC13726209",
      "source": "pmc",
      "url": "https://doi.org/10.1186/s13054-026-06204-5"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "journal-openalex:F27",
      "subfield": "general"
    }
  ],
  "title": "Coagulopathy and anticoagulation management in adult ECPR patients.",
  "title_text": "Coagulopathy and anticoagulation management in adult ECPR patients.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-06T12:22:13Z",
  "url": "https://research.draconitic.com/paper/4dncjxhn4cg8x",
  "venue": "Critical care (London, England)",
  "versions": []
}