Anticoagulation Management in Severe COVID-19 Patients on Extracorporeal Membrane Oxygenation

Abstract Objective To explore special coagulation characteristics and anticoagulation management in extracorporeal membrane oxygenation assisted patients with coronavirus disease 2019. Design This study is single center retrospective observation of a series of patients. Participants Laboratory-confirmed severe COVID-19 patients who received venovenous ECMO support from January 20th to May 20th, 2020. Interventions This study analyzed the anticoagulation management and monitoring strategies, bleeding complications, and thrombotic events during ECMO support. Results Eight of 667 confirmed COVID-19 patients received venovenous ECMO and had an elevated D-dimer before and during ECMO support. An ECMO circuit pack (oxygenator and tubing) was replaced a total of 13 times in all eight patients and coagulation related complications included oxygenator thrombosis (7/8), tracheal hemorrhage (5/8), oronasal hemorrhage (3/8), thoracic hemorrhage (3/8), bleeding at puncture sites (4/8), and cannulation site hemorrhage (2/8). Conclusions Hypercoagulability and secondary hyperfibrinolysis during ECMO support in COVID-19 patients are common and possibly increase the propensity for thrombotic events and failure of the oxygenator. Currently there is not enough evidence to support a more aggressive anticoagulation strategy.