Argatroban in patients with extracorporeal membrane oxygenation—a randomized controlled pilot trial

To the Editor Unfractionated heparin (UFH) is the most commonly used anticoagulant during extracorporeal membrane oxygenation (ECMO).1 However, UFH also has several limitations: (1) It requires individualized dosing and close monitoring; (2) its action depends on antithrombin (AT) levels, which may be reduced in some patients; (3) it binds to several proteins, including acute-phase reactants, making it difficult to achieve adequate dosing in patients with hyperinflammatory conditions; and (4) it carries a risk of heparin-induced thrombocytopenia (HIT), type II.2 Direct thrombin inhibitors (DTIs), including argatroban and bivalirudin, may overcome some limitations of UFH while providing similar or greater efficacy. However, the evidence for the use of DTIs in ECMO comes mainly from retrospective studies, which warrants conduct of prospective, randomized trials. This study was an investigator-initiated, prospective, randomized controlled pilot trial conducted in a medical intensive care unit at the Medical University of Vienna/University Hospital Vienna, a tertiary-care facility in Austria.