Extracorporeal membrane oxygenation (ECMO) is used for the management of severe respiratory and cardiac failure, as well as bridge to definite treatment or transplantation. ECMO associated coagulopathy (EAC) is a frequent complication leading to high rates of thrombosis or severe haemorrhage, contributing to morbidity and mortality of patients. Understanding the pathophysiology of EAC is substantial for effectively managing patients on ECMO. We analyse the underlying mechanism of EAC and discuss the monitoring of coagulation profile, combining the viscoelastic point of care assays with the conventional coagulation laboratory tests.