Anticoagulation after ECMO Decannulation-
After decannulation, patients were maintained on intravenous heparin or
bivalirudin for four days. The PTT goal was lowered one day after
decannulation to 50-70 seconds. Ultrasound studies were performed on
patients two to three days post decannulation and deep venous thrombosis
was identified in 4 patients (femoral veins and internal jugular vein).
The d-dimer remained elevated in all patients. Once discharged from the
ICU, the patients were transitioned to either a treatment dose
enoxaparin 1mg/kg or oral apixaban 5mg twice daily. This empiric
anticoagulation in the setting of elevated d-dimer testing was in
response to the high rate of pulmonary embolism (PE) reported in
multiple case series. For example, a 25% PE rate was reported in a
multicenter study from France of 150 patients (12). The patients were
discharged on oral apixaban with hematology follow up scheduled in two
weeks to recheck their d-dimer and determine the length of apixaban
treatment.