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It Takes Two to Bleed: Anticoagulation Intensity and the Host's Vascular Susceptibility
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We have read with interest the report of ELSO-registry data published by Nunez and coworkers in Intensive Care Medicine analyzing risk factors for bleeding and thrombotic events (BTE) on venovenous extra-corporeal membrane oxygenation (vv-ECMO) and clinical outcomes [1]. The abundance of data derivable from the ELSO-registry allows for powerful modeling, on which we congratulate the authors. Yet, we noticed with, admittedly, some disappointment that the data failed to unveil a single modifiable risk factor. The authors credit the observed decrease of BTE from 2010 to 2017 to advances in circuit composition, cannulation techniques and improved training, yet did not address the elephant in the room, the clinicians’ own contribution to tragedy: choice and intensity of anticoagulation.