Abstract

Extracorporeal membrane oxygenation (ECMO) is a mechanical life support system that dates back approximately 50 years. ECMO can be performed using veno-venous, veno-arterial, or hybrid methods and can also be used for extracorporeal cardiopulmonary resuscitation. In extracorporeal circulation, due to foreign surface contact or disruption of blood flow, the coagulation system is activated, making anticoagulant use essential. Standard practice involves using unfractionated heparin as an anticoagulant, but in some cases, its use may not be feasible. In such situations, an alternative anticoagulant agent must be selected, with direct thrombin inhibitors being the most commonly used. Our study focuses on the coagulation system and anticoagulant drugs used during ECMO, with a specific emphasis on bivalirudin. The study categorizes the data into two groups: the use of bivalirudin as a primary anticoagulant and its use as a secondary anticoagulant. A total of 28 sources were reviewed. With this study, we propose that direct thrombin inhibitors can serve as alternatives when heparin use is not possible. More experience is needed to clarify their efficacy and applicability.