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Updated: Jan 20, 2026
Veno-Venous Extracorporeal Membrane Oxygenation in a Mouse
Published on: October 24, 2018
Mortality and complications in low-dose vs standard-dose unfractionated heparin anticoagulation for extracorporeal
Wincy Wing-Sze Ng1, Rex Wan-Hin Hui2, Ka-Chun Leung3
1Adult Intensive Care Unit, Queen Mary Hospital, Hong Kong, China.
Background:
Controversies exist in anticoagulation practices in extracorporeal membrane oxygenation (ECMO). It is uncertain whether the intensity of anticoagulation affects ECMO outcomes.
Objectives:
To conduct a meta-analysis to determine whether anticoagulation intensity affects ECMO outcomes.
Methods:
The Medical Literature Analysis and Retrieval System Online, Embase, and Central Register of Controlled Trials' databases were searched from inception to October 2024 for trials comparing the use of low-dose (LD) and standard-dose unfractionated heparin anticoagulation in patients on ECMO. The primary outcome was short-term mortality. Secondary outcomes included major bleeding events, intracranial hemorrhage (ICH), oxygenator changes, systemic thrombotic events, and ECMO duration. Data were pooled using a random-effects meta-analysis. The risk-of-bias was assessed using the Cochrane Risk-of-Bias 2 tool for randomized controlled trials and the Risk-of-Bias in Non-Randomized Studies of Interventions for nonrandomized controlled trials.
Results:
Seven studies with 619 patients were included. LD anticoagulation was associated with significant reduction in the relative risk (RR) of mortality compared to standard-dose anticoagulation (RR, 0.69; 95% CI, 0.52-0.91; I 2 = 38%). Patients receiving LD anticoagulation had significantly lower risk of ICH (RR, 0.29; 95% CI, 0.13-0.63, I 2 = 0%), while the risk of major bleeding events was not significantly different between groups (RR, 0.78; 95% CI, 0.51-1.21; I 2 = 55%). LD anticoagulation did not significantly increase the risk of oxygenator changes (RR, 1.54; 95% CI, 0.94-2.53; I 2 = 42%) or systemic thrombotic events (RR, 1.27; 95% CI, 0.88-1.84; I 2 = 0%).
Conclusion:
This meta-analysis suggests that LD unfractionated heparin anticoagulation is associated with significantly better survival and a lower risk of ICH without an increase in the risk of thrombotic events. LD anticoagulation should be considered a reasonable strategy in ECMO.
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