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We read with great interest the analysis of data from the Extracorporeal Life Support Organization (ELSO)1 Registry. It provides valuable data that support the use of extracorporeal membrane oxygenation (ECMO) for patients with COVID-19. However, it is widely acknowledged that many critically ill patients with COVID-19 present with coagulation abnormalities that include thrombotic microangiopathy and venous and arterial thromboembolic complications.2, 3 Hence, anticoagulants have been used in these critically ill patients both therapeutically and prophylactically.4, 5 During ECMO support, continuous contact of circulating blood cells with the surface of the extracorporeal circuit leads to the hypercoagulable state. As a result, anticoagulant therapy is necessary. Although heparin dosage, monitoring assays, and target values selected by most centres are specified in the 2014 ELSO anticoagulation guideline, balancing thrombosis and haemostasis under the double hit of COVID-19 and ECMO is a big challenge for clinicians. For these reasons, it would have been valuable to record the types and dosages of anticoagulants, the anticoagulant monitoring methods, and the target values. The big data survey and the authoritative statistical analysis of the ELSO Registry data would make it clear whether patients with COVID-19 who receive ECMO require higher doses of heparin to increase clinical benefits and which monitoring method is most suitable.