Normalization of coagulation before LT-MCS implantation is crucial to avoid the postoperative cascade of bleeding, transfusions and volume overload, RV failure and surgical re-exploration. Preoperative temporary MCS, in particular, requires an antithrombotic regimen with intravenous drugs. Coagulopathy is inevitably present due to activation and consumption of coagulation factors secondary to cardiogenic shock and exposure to biomaterials and devices. This condition requires specific and more aggressive preoperative treatment.