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Peer-reviewedCC BY-NC-NDCritical care (London, England)

Coagulopathy and anticoagulation management in adult ECPR patients.

  • Sasa Rajsic1
  • Annemieke Oude Lansink-Hartgring2
  • Justyna Swol3
  • Walter M van den Bergh2
  • Mirjana Cvetkovic4
  • Peter Paul Roeleveld5
  • Ariane Willems6
  • Gabriel Putzer7
  • Nina Buchtele8
  • Louit Thakuria9
  • Waqas Akhtar10
  • Alex Rosenberg10
3 more authors
  • Mirko Belliato11
  • Jan Bělohlávek12,13
  • Christophe Vandenbriele14,15,16
16 affiliations
  1. 1Department of Anaesthesia and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, 6020, Austria. [email protected].
  2. 2Department of Critical Care, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
  3. 3Department of Respiratory Medicine, Paracelsus Medical University, Nuremberg, Germany.
  4. 4Great Ormond Street Hospital for Children, NHS Foundation Trust, University College London, London, UK.
  5. 5Paediatric intensive care Unit, Leiden University Medical Centre, Leiden, The Netherlands.
  6. 6Paediatric Intensive Care Unit, Department of Paediatrics, Queen Fabiola University Children's Hospital (University Hospital Brussels), Brussels, Belgium.
  7. 7Department of Anaesthesia and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, 6020, Austria.
  8. 8Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria.
  9. 9Hammersmith Hospital - Imperial College Healthcare, Imperial College University, London, UK.
  10. 10Guy's and St Thomas' NHS Foundation Trust, London, UK.
  11. 11Cardiothoracic ICU and Anaesthesia 2, Foundation IRCCS Policlinico San Matteo, Pavia, Italy.
  12. 12Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic.
  13. 13Institute for Heart Diseases, Wroclaw Medical University, Wrocław, Poland.
  14. 14Department of Anaesthesia and Critical Care, Royal Brompton & Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK.
  15. 15Division of Cancer and surgery, Faculty of Medicine, Imperial College, London, UK.
  16. 16Department of Cardiology and Cardiac Intensive Care, Heart Centre Aalst, Azorg Hospital, Aalst, Belgium.
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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.

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Cite

BibTeXRIS
BibTeX
@article{rajsic2026coagulopathy,
  title = {{Coagulopathy and anticoagulation management in adult ECPR patients.}},
  author = {Sasa Rajsic and Annemieke Oude Lansink-Hartgring and Justyna Swol and Walter M van den Bergh and Mirjana Cvetkovic and Peter Paul Roeleveld and Ariane Willems and Gabriel Putzer and Nina Buchtele and Louit Thakuria and Waqas Akhtar and Alex Rosenberg and Mirko Belliato and Jan Bělohlávek and Christophe Vandenbriele},
  journal = {Critical care (London, England)},
  year = {2026},
  month = aug,
  doi = {10.1186/s13054-026-06204-5},
  url = {https://europepmc.org/article/MED/42972582},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Coagulopathy and anticoagulation management in adult ECPR patients.
AU  - Sasa Rajsic
AU  - Annemieke Oude Lansink-Hartgring
AU  - Justyna Swol
AU  - Walter M van den Bergh
AU  - Mirjana Cvetkovic
AU  - Peter Paul Roeleveld
AU  - Ariane Willems
AU  - Gabriel Putzer
AU  - Nina Buchtele
AU  - Louit Thakuria
AU  - Waqas Akhtar
AU  - Alex Rosenberg
AU  - Mirko Belliato
AU  - Jan Bělohlávek
AU  - Christophe Vandenbriele
PY  - 2026
DA  - 2026/08/01
JO  - Critical care (London, England)
DO  - 10.1186/s13054-026-06204-5
UR  - https://europepmc.org/article/MED/42972582
AB  - 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.
SN  - 1364-8535
SN  - 1466-609X
ER  -