Prospective Observational Pilot Study of LMWH Versus UFH as ECMO Anticoagulation in Lung Transplantation

Inclusion Criteria: 1. ⃣ Adults (≥18 years old). 2. ⃣ Patients undergoing bilateral lung transplantation with perioperative veno-arterial (V-A) ECMO support. 3. ⃣ Planned perioperative anticoagulation with either UFH or LMWH, as determined by the attending anesthesiologist. 4. ⃣ Ability to provide informed consent or consent provided by a legally authorized representative. Exclusion Criteria: 1. ⃣ Patients receiving ECMO as a bridge to lung transplantation. 2. ⃣ Patients requiring postoperative continuation of ECMO. 3. ⃣ Patients with perioperative blood loss ≥3,000 mL. 4. ⃣ Patients undergoing lung re-transplantation. 5. ⃣ History of severe coagulopathy or bleeding disorder. 6. ⃣ Active use of antiplatelet or anticoagulant therapy (excluding study anticoagulants). 7. ⃣ Known heparin-induced thrombocytopenia (HIT). 8. ⃣ Severe liver dysfunction (Child-Pugh C) or end-stage renal disease requiring dialysis. 9. ⃣ Pregnant or breastfeeding women.