Anticoagulation in Critically Ill Adults during Extracorporeal Circulation

Area of Science:

• Critical Care Medicine
• Cardiovascular Engineering
• Nephrology

Background:

• Extracorporeal circuits (renal replacement therapy, ECMO, VADs) are vital for critically ill patients.
• Maintaining circuit patency requires effective anticoagulation, posing a significant clinical challenge.
• Current anticoagulation guidelines lack robust scientific evidence, relying heavily on expert opinion and institutional protocols.

Purpose of the Study:

• To provide a practical overview of current anticoagulation strategies for patients requiring extracorporeal assist devices.
• To address the challenges in anticoagulation management due to limited evidence and varied protocols.
• To synthesize expert opinions and practical approaches for optimizing anticoagulation in extracorporeal therapies.

Main Methods:

• Review of current literature and clinical practices regarding anticoagulation in extracorporeal circuits.
• Analysis of expert opinions and common institutional protocols for anticoagulation management.
• Discussion of challenges related to anticoagulant selection, monitoring, and target ranges.

Main Results:

• Significant variability exists in anticoagulation protocols across different centers.
• Optimal anticoagulant choice, monitoring methods, and therapeutic targets remain areas of low scientific evidence.
• Expert opinions and 'in-house' protocols are the primary drivers of current anticoagulation practices.

Conclusions:

• Anticoagulation management for extracorporeal devices is complex and often based on limited evidence.
• Further research is needed to establish evidence-based guidelines for anticoagulation in these patient populations.
• This review offers a practical perspective to guide clinicians in managing anticoagulation for extracorporeal therapies.