Protti A, et al. - In view of a lack of agreement on how to manage anticoagulation during veno-venous extracorporeal membrane oxygenation, including antithrombin monitoring and supplementation, researchers sought to ascertain current practice in a large number of extracorporeal membrane oxygenation centers around the world. In 2018, they administered an electronic survey to directors and coordinators of extracorporeal membrane oxygenation centers as well as to extracorporeal membrane oxygenation experts. Two hundred seventy-three unique responses were analyzed from 50 countries. The analysis revealed that institutions vary largely in practice concerning anticoagulation management and antithrombin supplementation during veno-venous extracorporeal membrane oxygenation. In 264 (96.7%) centers, routine prescription of systemic anticoagulation is made, with unfractionated heparin being the drug of choice in 255 (96.6%) of them. To monitor anticoagulation, the preferred method was activated partial thromboplastin time in 114 (41.8%) centers, activated clotting time in 82 (30.0%) centers, and anti-factor Xa activity in 62 (22.7%) centers. In 133 (48.7%) centers, routine monitoring of circulating antithrombin activity is done. In 104 (38.1%) centers, the routine prescription of antithrombin supplementation is made. At multivariable analyzes, an association of routine antithrombin supplementation with national income was identified; routine antithrombin supplementation was less likely in lower vs higher-income countries; with primary patient population being more frequent in mixed and pediatric-only centers than in adult-only centers.