AM26-MO-39-L - AABB/THOR - Hemostasis and Transfusion Management in Cardiac Surgery and ECMO: Evidence, Controversies, and Emerging Strategies

Monday, October 19, 2026

4:30 PM - 5:30 PM EST

Room: GWCC B5 Thomas Murphy 2-3

Program Chair(s)

Nabiha H. Saifee, MD, PhD (she/her/hers)

Transfusion Service Medical Director
Seattle Children's
Seattle, Washington

Speaker(s)

Nabiha H. Saifee, MD, PhD (she/her/hers)

Transfusion Service Medical Director
Seattle Children's
Seattle, Washington
Cristina Figueroa Villalba, MD

Apheresis Medical Director and Transfusion Service Associate Director
Seattle Children’s
Marianne Nellis, MD, MS (she/her/hers)

Associate Professor of Pediatrics
Weill Cornell Medicine
NEW YORK, New York
DT

Dr. Kenichi Tanaka, MD, MS

Professor and Chair
Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
Oklahoma city, Oklahoma

Patients supported by extracorporeal membrane oxygenation (ECMO) and those undergoing cardiac surgery with cardiopulmonary bypass (CPB) have unique hemostatic needs. Balancing the risk of bleeding and thrombosis requires an integrated approach to anticoagulation, laboratory monitoring, transfusion, and blood conservation. This session brings together expertise from laboratory medicine, coagulation, transfusion medicine, critical care, and anesthesia to discuss non-trauma hemostasis in ECMO and cardiac surgery. First Dr. Figueroa Villalba, a coagulation and transfusion medicine expert, will examine the role of anticoagulation in the fine balance between bleeding and clotting in patients on ECMO and compare the utility of anti-Xa, dilute thrombin time (dTT), aPTT, and viscoelastic testing for anticoagulation monitoring. Next, Dr, Marianne Nellis, a critical care medicine physician and leader in transfusion medicine research, will discuss transfusion practices in ECMO, including the multifactorial drivers of transfusion — hemodilution, circuit-mediated platelet consumption, acquired von Willebrand syndrome, and diagnostic phlebotomy — and the evidence from recent and ongoing clinical trials (TITRE, ECSTATIC) comparing restrictive versus liberal transfusion strategies. Finally, Dr. Kenichi Tanaka, a cardiac anesthesiologist and coagulation expert, will discuss patient blood management in cardiac surgery. He will evaluate the efficacy and safety of prothrombin complex concentrate (PCC) versus plasma for coagulopathic bleeding, with discussion of the FARES-II trial and safety signals such as thrombosis and acute kidney injury. Dr. Tanaka will also discuss acute normovolemic hemodilution (ANH) as a blood conservation strategy, integrating the recent ANH Trial and STS database analysis, and exploring the use viscoelastic testing in the context of ANH. Together, this session provides a comprehensive, evidence-based framework for optimizing hemostasis and transfusion for patients on ECMO and undergoing cardiac surgery.

Learning Objectives:

Outline an anticoagulation monitoring framework for patients on ECMO that balances circuit thrombosis against bleeding risks
Evaluate the clinical utility and limitations of different laboratory assays (Anti-Xa, ACT, aPTT, dTT, and Viscoelastic Testing) for monitoring heparin and bivalirudin
Analyze factors (e.g., hemodilution, circuit consumption, and phlebotomy) that drive increased transfusion in patients on ECMO
Review recent clinical trials (TITRE, ECSTATIC) comparing restrictive versus liberal transfusion thresholds in patients on ECMO
Evaluate the comparative efficacy and safety of 4-factor prothrombin complex concentrate (PCC) versus plasma for the management of coagulopathic bleeding in cardiac surgery, including the evolving evidence on thrombotic risk and acute kidney injury
Critically appraise the current evidence for acute normovolemic hemodilution (ANH) as a blood conservation strategy in cardiac surgery — including the role of collection volume, patient selection, and viscoelastic testing (VET) in optimizing hemostatic outcomes after autologous whole blood reinfusion