Anticoagulation in the ICU: a future for contact pathway inhibition?

Charlotte J Van Edom, Diana Gorog, Christophe Vandenbriele

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Bleeding and thrombotic complications are the main cause of morbidity and mortality in critically ill patients on the intensive care unit (ICU), receiving short-term percutaneous mechanical circulatory support (pMCS) by extracorporeal membrane oxygenation (ECMO), balloon pumps or microaxial flow pumps [1]. This is due to a bidirectional interplay of various factors influencing the haemostatic balance, including coagulopathy during critical illness, sepsis/inflammation, platelet consumption, hyperfibrinolysis, shear-induced acquired von Willebrand syndrome and direct contact pathway activation by the artificial surface of the pMCS device [2]. To prevent thrombotic complications and device-induced localised intravascular coagulopathy (LIC), anticoagulation is indicated. Unfortunately, all currently available anticoagulants carry an increased bleeding risk, further jeopardising patients’ outcomes [3]. Therefore, the search for safer anticoagulants continues: the holy grail for the treatment of patients on pMCS and by extension, all patients on anticoagulation is to prevent thrombosis without affecting haemostasis, thus lowering the bleeding risk
Original languageEnglish
JournalIntensive Care Medicine
Publication statusPublished - 31 Jul 2023


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