Fibrinolysis is poorly investigated in ECMO patients, partly due to a lack of routine laboratory tests evaluating fibrinolysis. Hence, hyperfibrinolysis may be a contributor to bleeding risk during ECMO treatment.

However, in the work of Helms et al., the increase in D-dimer is more likely a reflection of increased fibrin turnover due to increased thrombin generation as presented by our group.

Antifibrinolytic therapy should not be initiated on the basis of D-dimer measurements, but should follow the evaluation of fibrinolysis, e.g., with viscoelastic assays.

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