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Unfractionated heparin (UFH) is currently the most commonly used anticoagulant for pediatric and adult ECMO.2,3 Unfractionated heparin is a glycosaminoglycan that binds to antithrombin (AT) to produce a 1,000-fold increase in AT inhibition of thrombin, factor Xa, factor XIIa, and factor IXa.4