{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T03:08:10Z","timestamp":1780628890458,"version":"3.54.1"},"reference-count":132,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T00:00:00Z","timestamp":1762128000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"},{"start":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T00:00:00Z","timestamp":1762128000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Extracorporeal membrane oxygenation (ECMO) is increasingly being utilized in critical care globally to allow for adequate oxygenation in patients with cardiac and\/or respiratory failure. Unfortunately, haemostatic complications \u2013 both thrombotic and haemorrhagic \u2013 are commonplace. Well established contributors to haemostatic dysfunction include patient-level characteristics, features of ECMO itself and the requirement of systemic anticoagulation to prevent circuit-related thrombosis. Research has focused on understanding how ECMO devices impact upon cellular components, particularly platelets, and plasma proteins involved in coagulation through assessment of phenotypic changes and activation profiles. A central feature of ECMO is the significant haemodynamic disturbances cells and circulating proteins experience within ECMO circuits. Given the body of evidence detailing the effects of haemodynamic shear on circulating cells critical for haemostasis, there is renewed focus on understanding the impact of shear on haemostatic dysfunction in ECMO. In this review, we describe the current landscape of ECMO-associated thrombosis and haemorrhage, provide insights into the impact of anticoagulation on haemostatic complications and highlight research evaluating the impact of shear on circulating cells and plasma proteins involved in haemostasis. Finally, we also discuss potential modifiers of haemostatic complications with a focus on development of personalized diagnostic and management approaches.<\/jats:p>","DOI":"10.1002\/ejhf.70075","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T20:19:33Z","timestamp":1762201173000},"page":"3352-3365","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Shear-Induced Dysregulation of Haemostasis During Extracorporeal Membrane Oxygenation: From Cells to Circuit"],"prefix":"10.1093","volume":"27","author":[{"given":"Danielle H.","family":"Robinson","sequence":"first","affiliation":[{"name":"Department of Clinical Haematology, Alfred Health , Melbourne, VIC ,","place":["Australia"]},{"name":"The Australian Centre for Blood Diseases, School of Translational Medicine, Monash University , Melbourne, VIC ,","place":["Australia"]},{"name":"Atherothrombosis and Vascular Biology Program, Baker Heart and Diabetes Institute , Melbourne, VIC ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karlheinz","family":"Peter","sequence":"additional","affiliation":[{"name":"Atherothrombosis and Vascular Biology Program, Baker Heart and Diabetes Institute , Melbourne, VIC ,","place":["Australia"]},{"name":"Baker Department of Cardiometabolic Health, University of Melbourne , Melbourne, Victoria ,","place":["Australia"]},{"name":"Department of Medicine, School of Translational Medicine, Monash University , Melbourne, Victoria ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James D.","family":"McFadyen","sequence":"additional","affiliation":[{"name":"Department of Clinical Haematology, Alfred Health , Melbourne, VIC ,","place":["Australia"]},{"name":"The Australian Centre for Blood Diseases, School of Translational Medicine, Monash University , Melbourne, VIC ,","place":["Australia"]},{"name":"Atherothrombosis and Vascular Biology Program, Baker Heart and Diabetes Institute , Melbourne, VIC ,","place":["Australia"]},{"name":"Baker Department of Cardiometabolic Health, University of Melbourne , Melbourne, Victoria ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,11,3]]},"reference":[{"key":"2026021721520732900_ejhf70075-bib-0001","doi-asserted-by":"crossref","DOI":"10.3390\/diagnostics13233496","article-title":"Extracorporeal membrane oxygenation (ECMO)-associated coagulopathy in adults","volume":"13","author":"Frantzeskaki","year":"2023","journal-title":"Diagnostics"},{"key":"2026021721520732900_ejhf70075-bib-0002","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1097\/MAT.0000000000001652","article-title":"2021 ELSO adult and pediatric anticoagulation guidelines","volume":"68","author":"McMichael","year":"2022","journal-title":"ASAIO J"},{"key":"2026021721520732900_ejhf70075-bib-0003","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1002\/phar.2857","article-title":"Review of anticoagulation considerations in extracorporeal membrane oxygenation support","volume":"43","author":"Graboyes","year":"2023","journal-title":"Pharmacotherapy"},{"key":"2026021721520732900_ejhf70075-bib-0004","doi-asserted-by":"crossref","DOI":"10.1002\/clc.70061","article-title":"Anticoagulation monitoring during ECMO support: Monitor or flip a coin?","volume":"47","author":"Rajsic","year":"2024","journal-title":"Clin Cardiol"},{"key":"2026021721520732900_ejhf70075-bib-0005","doi-asserted-by":"crossref","DOI":"10.1002\/clc.24273","article-title":"Association of anti-factor Xa-guided anticoagulation with hemorrhage during ECMO support: A systematic review and meta-analysis","volume":"47","author":"Rajsic","year":"2024","journal-title":"Clin Cardiol"},{"key":"2026021721520732900_ejhf70075-bib-0006","article-title":"Bleeding during veno-venous ECMO: Prevention and treatment","volume":"9","author":"Kalbhenn","year":"2022","journal-title":"Front Med (Lausanne)"},{"key":"2026021721520732900_ejhf70075-bib-0007","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1186\/s12967-023-04174-8","article-title":"The serum proteome of VA-ECMO patients changes over time and allows differentiation of survivors and non-survivors: An observational study","volume":"21","author":"Siegel","year":"2023","journal-title":"J Transl Med"},{"key":"2026021721520732900_ejhf70075-bib-0008","doi-asserted-by":"crossref","first-page":"19458","DOI":"10.1074\/jbc.270.33.19458","article-title":"The interaction of fibulin-1 with fibrinogen. 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