If CPB is used, the suggested heparin dose is 400 IU/kg with a target activated clotting time of >400 s. If the patient is on extracorporeal membrane oxygenation (ECMO) or the ECMO remains implanted for a period after LVAD implantation (e.g. for support of the RV), a dose of 100 IU/kg heparin and a target activated clotting time of 160–180 s is recommended. Similarly, off-pump LVAD implantation is usually performed under heparin 100 IU/kg. Thromboelastometry- and thromboelastography-guided therapy results in a significantly lower re-exploration rate [240, 241] and a decrease in the incidence of postoperative acute kidney injury [242].