Clinical Outcomes of Different Heparin Anticoagulation Monitoring Targets in Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-analysis
Authors' conclusion
The findings of this systematic review and meta-analysis indicate a potential association between conservative anticoagulation strategies during ECMO and reduced bleeding events without increased mortality or thrombotic complications, including stroke, limb ischemia, and circuit thrombosis.
Study context
- Population
- Patients on venovenous or venoarterial extracorporeal membrane oxygenation (ECMO) in ICUs across multiple international centres
- Participants
- 601 patients · 8 studies
- Comparison
- Conservative vs standard heparin anticoagulation during ECMO
- Conservativen = 280
- Standardn = 321reference
- Outcome
- Mortality, major bleeding and thrombosis
Methodological detailsPRISMA, random-effects models, venovenous and venoarterial ECMO
- PRISMA
- Random-effects models
- Venovenous and venoarterial ECMO
Pooled result
Mortality
Odds ratio
1.04
95% CI 0.53–2.05
Events by group
Conservative vs Standard
OR 1.04 (95% CI 0.53–2.05)
As reported in the abstract
Further pooled results
- Stroke: 5 of 127 vs 5 of 178; did not differ between groups
- Limb ischaemia: 10 of 87 vs 20 of 147; did not differ between groups
- Circuit thrombosis: 15 of 141 vs 15 of 191; did not differ between groups
Safety
| Outcome | Conservative | Standard | OR (95% CI) | P value | |
|---|---|---|---|---|---|
| Major bleeding (primary outcome)I² = 72% | 29.5% | 52.9% | 0.40 (0.18–0.91) | P = 0.03 | |
| Thrombotic events (primary outcome)I² = 0% | 21.1% | 26.4% | 0.60 (0.33–1.09) | ||
| 0.20.5125Odds ratio (log scale) |
- Major bleeding (primary outcome): 7 studies
- Thrombotic events (primary outcome): 4 studies
Original publication
Clinical Outcomes of Different Heparin Anticoagulation Monitoring Targets in Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-analysis. J Cardiothorac Vasc Anesth. Published 20 April 2026. doi:10.
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