Is Antithrombin Supplementation Effective in Suppressing ECMO Circuit Thrombosis in Sepsis?

Extracorporeal membrane oxygenation (ECMO) is increasingly used for the management of severe sepsis-induced cardiopulmonary failure. Despite standard heparin anticoagulation, circuit thrombosis remains a significant complication. Antithrombin (AT), a critical serine protease inhibitor and cofactor for heparin, is often low in septic patients, especially during ECMO, raising concerns about the efficacy of heparin-based anticoagulation. This review explores the role of AT supplementation to suppress ECMO circuit thrombosis in sepsis, integrating epidemiological data, underlying pathophysiology, preclinical research, and clinical evidence. While theoretical rationale and some observational data support the supplementation of AT, definitive clinical trials are lacking. We conclude by outlining future perspectives and research needs to clarify the role of AT in ECMO management for septic patients.