The aim of this observational pilot study is to evaluate the effectiveness and safety of low-molecular-weight heparin (LMWH) compared to unfractionated heparin (UFH) as anticoagulation in perioperative ECMO during bilateral lung transplantation.
The main question this study seeks to answer is:
Does LMWH provide a safe and effective alternative to UFH for ECMO anticoagulation in lung transplantation, with reduced bleeding and thrombotic complications?
Patients undergoing bilateral lung transplantation with perioperative veno-arterial (V-A) ECMO support will be assigned to one of two anticoagulation strategies:
UFH group: Standard UFH anticoagulation monitored using ROTEM. LMWH group: Enoxaparin-based anticoagulation monitored using ROTEM. The study will assess perioperative blood loss, hemoglobin levels, transfusion needs, and thrombotic events. Additional analyses will include coagulation profile assessments using point-of-care (POC) tests, thrombin generation test (TGT), and laboratory coagulation parameters.
⃣ Adults (≥18 years old).
⃣ Patients undergoing bilateral lung transplantation with perioperative veno-arterial (V-A) ECMO support.
⃣ Planned perioperative anticoagulation with either UFH or LMWH, as determined by the attending anesthesiologist.
⃣ Ability to provide informed consent or consent provided by a legally authorized representative.
⃣ Patients receiving ECMO as a bridge to lung transplantation.
⃣ Patients requiring postoperative continuation of ECMO.
⃣ Patients with perioperative blood loss ≥3,000 mL.
⃣ Patients undergoing lung re-transplantation.