A concerning trend has emerged within the regenerative medicine community. Some practitioners performing Extracorporeal Blood Oxygenation and Ozonation, also known as EBO2 or EBOO, are presenting blood clots formed during treatment as evidence that the therapy is working. This interpretation reflects a fundamental misunderstanding, or misrepresentation, of extracorporeal therapy principles and raises serious concerns regarding patient safety and informed consent.
Understanding Anticoagulation in EBO2
EBO2 is an extracorporeal procedure in which blood is temporarily removed from the body, exposed to oxygen and ozone, and then returned through a filtration system. Like all extracorporeal therapies, it requires strict anticoagulation to prevent clot formation within the circuit.
The International Scientific Committee of Ozone Therapy, known as ISCO3, has established clear anticoagulation protocols for EBO2. These guidelines specify that the contactor and blood lines must be flushed with a heparin solution containing 2,500 to 5,000 international units, with a total maximum dose of 10,000 international units during the procedure.
When blood comes into contact with artificial tubing and filters, it naturally activates the clotting cascade. Heparin is used specifically to prevent this response. If clotting is observed at any point, such as a clogged filter in the return line, protocols require immediate administration of an additional 2,000 to 3,000 international units of heparin.
The Problem: Complications Presented as Benefits
In recent social media content, some practitioners have displayed large blood clots removed from EBO2 circuits, in some cases reportedly measuring up to two feet in length. These images are often paired with marketing phrases such as “blood oil change” or “what’s in your blood,” implying that the clots represent harmful material removed from the patient’s circulation.
This is a dangerous mischaracterization. The clots forming in the extracorporeal circuit are not pre-existing pathology. They are not toxins, plaque, or debris being filtered from the bloodstream. They are iatrogenic, meaning they are directly caused by the procedure itself, specifically by inadequate anticoagulation.
Why Clot Formation Signals Protocol Failure
Visible clot formation during EBO2 indicates multiple failures in protocol. First, the initial heparin dose was insufficient. Second, proper monitoring for clot formation was lacking. Third, the procedure appears to have continued despite clear evidence of thrombosis, rather than being corrected with additional anticoagulation as required.
Heparin has a short half life of approximately thirty minutes. After one hour, only about twenty five percent of its activity remains. Without vigilant monitoring and supplemental dosing, clot formation becomes predictable rather than exceptional.
In other extracorporeal therapies, such as extracorporeal membrane oxygenation or ECMO, clotting within the circuit is considered a serious complication that requires immediate intervention. It is never viewed as a therapeutic success.
Patient Safety Implications
Presenting procedural complications as therapeutic benefits introduces significant safety concerns. Patients cannot provide truly informed consent if they are told that evidence of inadequate anticoagulation represents successful treatment.
The presence of large or multiple clots suggests systemic under anticoagulation, which carries theoretical risks, including the possibility that clot fragments could enter the circulation. While EBO2 is designed to be safe when properly performed, deviations from established protocols increase unnecessary risk.
This type of marketing may also erode adherence to anticoagulation standards. If clot formation is viewed as a desired outcome rather than a warning sign, practitioners may become less diligent about maintaining appropriate heparin levels throughout treatment.
Professional Responsibility in Regenerative Medicine
As physicians and clinicians offering advanced regenerative therapies, we have a responsibility to uphold rigorous scientific and clinical standards. EBO2 is a legitimate therapy when performed correctly, with protocols developed by international scientific organizations.
However, its credibility, and the credibility of regenerative medicine as a whole, is undermined when procedural complications are reframed as therapeutic achievements.
When evaluating EBO2 providers or considering referrals, practitioners should ask specific questions about anticoagulation protocols, monitoring practices, and complication management. Blood clot formation during EBO2 should be recognized for what it is: evidence of inadequate technique that requires immediate correction, not a marketing opportunity.
Moving Forward
The regenerative medicine community must hold itself to high professional standards. Our commitment must remain rooted in scientific accuracy, patient safety, and transparent informed consent.
Effective medical procedures are not defined by dramatic visuals or social media appeal. In fact, when EBO2 is performed correctly, it should not produce the kind of complications that make for attention grabbing content. Patients deserve honesty, precision, and care grounded in sound medical practice.
