Extracorporeal membrane oxygenation (ECMO) represents an advanced technique for the support of cardiopulmonary function in intensive care, especially demonstrating notable efficacy in the treatment of cardiogenic shock and severe respiratory failure. Nonetheless, common bleeding and thrombotic complications associated with ECMO treatment seriously impacts patients' prognosis, anticoagulation management becomes the key. This paper systematically reviews the existing studies and relevant guidelines/expert consensus on ECMO anticoagulation management, analyzes the physiological basis of anticoagulation management during ECMO treatment, and explores selection and mechanism of anticoagulant drugs, anticoagulation monitoring methods and targets, influencing factors for anticoagulation management and individualized anticoagulation management strategies, risk management and treatment of bleeding and thrombosis, and individualized anticoagulation management strategies for different patient groups. In view of the challenges and controversies in anticoagulation management during ECMO treatment, this paper emphasizes the importance of individualized treatment and discusses future research directions, such as the development of novel anticoagulant drugs, the application of precise monitoring methods, and the necessity of multidisciplinary collaboration to optimize clinical practice and improve therapeutic effect.

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