Unfractionated heparin has long been considered the standard anticoagulation in ECMO, despite some pitfalls such as heparin resistance, heparin induced thrombocytopenia (HIT), etc Recently, some centres started to increasingly use argatroban for this purpose, typically using activated partial thromboplastin time (aPTT) for its monitoring. Direct monitoring of the efficacy of argatroban using Anti-IIa is not yet an established method, although it might be more appropriate as it targets the same pathway.An observational study was performed in adult veno-venous ECMO patients hospitalized with SARS-CoV-2 infection anticoagulated with argatroban to an aPTT target of 40-60 s and Anti-IIa target of 0.4-0.6 µg/mL. Bleeding and thrombotic complications were monitored.Forty-four VV ECMO patients were included, with an overall hospital mortality of approx. 50%. No life-threatening thrombotic events were recorded. The risk of bleeding complications significantly increased with aPTT above 52.7 s and with Anti-IIa values over 0.78 µg/mL. Using the above cut-offs for both the aPTT and Anti-IIa and their combination, the negative predictive value for bleeding was approximately 90%.It seems that the generally recommended limits for Anti-IIa of 1.5 µg/mL may be high. However, further data are needed to confirm lower limits.Trial Registration:retrospectively registered in ClinicalTrials.gov, NCT06038682.

Center for Health Research Faculty of Medicine University of Ostrava Syllabova 19 703 00 Ostrava Czech Republic

Department of Anaesthetics Resuscitation and Intensive Care Medicine University Hospital Ostrava 17 listopadu 1790 708 00 Ostrava Czech Republic

Department of Applied Mathematics Faculty of Electrical Engineering and Computer Science VSB Technical University of Ostrava 17 listopadu 2172 15 708 00 Ostrava Czech Republic

Department of Infectious Diseases University Hospital Ostrava 17 listopadu 1790 708 00 Ostrava Czech Republic

Department of the Deputy Director for Science Research and Education University Hospital Ostrava 17 listopadu 1790 708 00 Ostrava Czech Republic

Institute of Physiology and Pathophysiology Faculty of Medicine University of Ostrava Syllabova 19 703 00 Ostrava Czech Republic

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ClinicalTrials.gov
NCT06038682