Consumptive coagulopathy: how low-dose unfractionated heparin can prevent bleeding complications during extracorporeal life support

Bleeding and thrombotic complications are major drivers in extracorporeal life support (ECLS) patients’ negative outcomes and are reported in up to 40% of the ECLS-runs [1, 2]. Consumptive coagulopathy is a crucial concept in (acute) intensive care, often receiving insufficient attention in the management and treatment of ECLS patients. Nevertheless, it strongly influences the patient’s prognosis [3, 4]. Triggers for consumptive coagulopathy can be diverse, but fundamentally the process always results in (a) depletion of coagulation factors (clotting factors, fibrinogen, platelet counts, etc.), (b) increased thrombus formation (often at microvascular level, reflected in elevated D-dimer levels; and resulting in end-organ damage), and (c) increased tendency to bleed [3]. Deficiency in coagulation factors and/or fibrinogen often manifests as (spontaneous) prolongation of common coagulation tests (international normalized ratio [INR], activated partial thromboplastin time [APTT]) but does not affect the anti-Xa assay. This illustrates the importance of using a combination of anticoagulation tests in ECLS-supported patients [5, 6]. …