Association Between Systemic Anticoagulation and Outcomes in Patients With Acute Respiratory Distress Syndrome Receiving Venovenous Extracorporeal Membrane Oxygenation: Insights From a Multicenter Propensity-Weighted Study

OBJECTIVE: To evaluate whether systemic anticoagulation therapy affects the survival of adult patients receiving venovenous extracorporeal membrane oxygenation (VV-ECMO) for acute respiratory distress syndrome (ARDS). DESIGN: Multicenter retrospective study. SETTING: Twenty-four ICUs in Japan. PATIENTS: Six hundred and ninety-five patients received VV-ECMO for ARDS. Patients were divided into the anticoagulation group and the no-anticoagulation group according to whether or not they received anticoagulant therapy. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: In the propensity score-overlap-weighted analysis, there was no significant difference in the 28-day survival (85.8% vs. 81.5%, p = 0.50) between the two groups. The 60-day survival, ECMO duration, circuit exchanges, bleeding complications, and transfusion volumes were also comparable. The anticoagulation group had a significantly higher average activated partial thromboplastin time during ECMO (51.3 s vs. 39.3 s, p < 0.01). These findings remained consistent in the sensitivity analysis using inverse probability of treatment weighting. CONCLUSIONS: Systemic anticoagulation was not associated with short-term survival. Anticoagulation-free VV-ECMO may be feasible in patients at high-bleeding risk, but safety remains uncertain. Further studies should clarify optimal anticoagulation strategies.