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.