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Membranes
Volume 11
Issue 8
10.3390/membranes11080617
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Review

New Trends, Advantages and Disadvantages in Anticoagulation and Coating Methods Used in Extracorporeal Life Support Devices

by
Anne Willers
1,2,*,†,
Jutta Arens
3,†,
Silvia Mariani
1,2,
Helena Pels
3,
Jos G. Maessen
1,2,
Tilman M. Hackeng
2,4,
Roberto Lorusso
1,2 and
Justyna Swol
5,*
1
ECLS Centre, Cardio-Thoracic Surgery, and Cardiology Department, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
2
Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
3
Engineering Organ Support Technologies Group, Department of Biomechanical Engineering, Faculty of Engineering Technology, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
4
Department of Biochemistry, Faculty of Health, Medicine and Life, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
5
Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University, Ernst-Nathan Str. 1, 90419 Nuremberg, Germany
*
Authors to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Membranes 2021, 11(8), 617; https://doi.org/10.3390/membranes11080617
Submission received: 20 July 2021 / Revised: 6 August 2021 / Accepted: 8 August 2021 / Published: 12 August 2021
(This article belongs to the Special Issue Challenges in the Extracorporeal Membrane Oxygenation Era)
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Abstract

The use of extracorporeal life support (ECLS) devices has significantly increased in the last decades. Despite medical and technological advancements, a main challenge in the ECLS field remains the complex interaction between the human body, blood, and artificial materials. Indeed, blood exposure to artificial surfaces generates an unbalanced activation of the coagulation cascade, leading to hemorrhagic and thrombotic events. Over time, several anticoagulation and coatings methods have been introduced to address this problem. This narrative review summarizes trends, advantages, and disadvantages of anticoagulation and coating methods used in the ECLS field. Evidence was collected through a PubMed search and reference scanning. A group of experts was convened to openly discuss the retrieved references. Clinical practice in ECLS is still based on the large use of unfractionated heparin and, as an alternative in case of contraindications, nafamostat mesilate, bivalirudin, and argatroban. Other anticoagulation methods are under investigation, but none is about to enter the clinical routine. From an engineering point of view, material modifications have focused on commercially available biomimetic and biopassive surfaces and on the development of endothelialized surfaces. Biocompatible and bio-hybrid materials not requiring combined systemic anticoagulation should be the future goal, but intense efforts are still required to fulfill this purpose.
Keywords: extracorporeal life support; extracorporeal membrane oxygenation; anticoagulation; circuit modifications; coating methods extracorporeal life support; extracorporeal membrane oxygenation; anticoagulation; circuit modifications; coating methods

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MDPI and ACS Style

Willers, A.; Arens, J.; Mariani, S.; Pels, H.; Maessen, J.G.; Hackeng, T.M.; Lorusso, R.; Swol, J. New Trends, Advantages and Disadvantages in Anticoagulation and Coating Methods Used in Extracorporeal Life Support Devices. Membranes 2021, 11, 617. https://doi.org/10.3390/membranes11080617

AMA Style

Willers A, Arens J, Mariani S, Pels H, Maessen JG, Hackeng TM, Lorusso R, Swol J. New Trends, Advantages and Disadvantages in Anticoagulation and Coating Methods Used in Extracorporeal Life Support Devices. Membranes. 2021; 11(8):617. https://doi.org/10.3390/membranes11080617

Chicago/Turabian Style

Willers, Anne, Jutta Arens, Silvia Mariani, Helena Pels, Jos G. Maessen, Tilman M. Hackeng, Roberto Lorusso, and Justyna Swol. 2021. "New Trends, Advantages and Disadvantages in Anticoagulation and Coating Methods Used in Extracorporeal Life Support Devices" Membranes 11, no. 8: 617. https://doi.org/10.3390/membranes11080617

APA Style

Willers, A., Arens, J., Mariani, S., Pels, H., Maessen, J. G., Hackeng, T. M., Lorusso, R., & Swol, J. (2021). New Trends, Advantages and Disadvantages in Anticoagulation and Coating Methods Used in Extracorporeal Life Support Devices. Membranes, 11(8), 617. https://doi.org/10.3390/membranes11080617

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