Low-Intensity vs Moderate-Intensity Anticoagulation for Venovenous Extracorporeal Membrane Oxygenation: The Strategies for Anticoagulation During Venovenous Extracorporeal Membrane Oxygenation Pilot Trial

Gannon, WD; Pratt, EH; Vogelsong, MA; Adkisson, WH; Bacchetta, M; Bloom, SL; Ford, DJ; Guenthart, BA; Landsperger, JS; Qian, ET; Rackley, CR; Rice, TW; Fielding-Singh, V; Stokes, JW; Stollings, JL; Semler, MW; Casey, JD; Pragmatic Critical Care Research Group

doi:10.1016/j.chest.2025.02.032

Organ support & nutrition

Low-Intensity vs Moderate-Intensity Anticoagulation for Venovenous Extracorporeal Membrane Oxygenation: The Strategies for Anticoagulation During Venovenous Extracorporeal Membrane Oxygenation Pilot Trial

ChestPublished 11 Mar 2025Randomised controlled trial

Primary result · Major bleedingResultAbsolute risk difference −20.2 percentage points 95% CI −48.6 to 8.1

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Authors' conclusion

Our results indicate that enrollment and separation between groups are feasible in a multicenter randomized trial of low-intensity vs moderate-intensity anticoagulation for critically ill adults receiving venovenous ECMO.

Study context

Population: Critically ill adults undergoing venovenous extracorporeal membrane oxygenation (ECMO), 3 US centresall received assigned intensity
Participants: 26 adults

Comparison: Low-intensity vs Moderate-intensity
Low-intensityn = 12
Moderate-intensityn = 14reference
Primary endpoint: Major bleeding (primary efficacy outcome); feasibility assessed by enrollment rate and adherence to assigned anticoagulation
Follow-up: Between enrollment and 24 hours after decannulation

Methodological detailspilot, multicentre, parallel-group

Pilot
Multicentre
Parallel-group

Primary result

Major bleeding · enrollment to 24 hours after decannulation

Absolute risk difference

−20.2 percentage points

95% CI −48.6 to 8.1

P = 0.33

Events by treatment group

Low-intensity8.3%1 of 12

Moderate-intensity28.6%4 of 14

Low-intensity vs Moderate-intensity

absolute risk difference −20.2 percentage points (95% CI −48.6 to 8.1); P = 0.33

As reported in the abstract

Further findings

Outcome	Low-intensity	Moderate-intensity
Death before dischargeBoth deaths in patients with major bleeding events	0 events	14.3%

Safety

Outcome	Low-intensity	Moderate-intensity	← Lower with low-intensity ←→ Higher with low-intensity →	Difference (percentage points) (95% CI)	P value
Thromboembolic events (primary safety outcome) · enrollment to 24 hours after decannulation	8.3%	0 events	−100102030	8.3 (−7.3 to 24.0)	P = 0.46
			−100102030Difference, percentage points (linear scale)

Original publication

Low-Intensity vs Moderate-Intensity Anticoagulation for Venovenous Extracorporeal Membrane Oxygenation: The Strategies for Anticoagulation During Venovenous Extracorporeal Membrane Oxygenation Pilot Trial. Chest. Published 11 March 2025. doi:10.1016/j.chest.2025.02.032

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