Objective To explore the safety and effectiveness of thromboelastography (TEG) based anticoagulant management in extracorporeal membrane oxygenation (ECMO). Methods A total of 54 patients who underwent ECMO treatment in Xuzhou Central Hospital due to explosive myocarditis from September 2015 to April 2022 were included. According to the random number table method, they were divided into two groups: an activated partial thromboplastin time (APTT) group (n=26) and a TEG group (n=28). Their anticoagulation management was guided by TEG or APTT. The general information, related complications, in‑hospital mortality, death related complications, and the incidence of bleeding and thrombosis events were recorded. Their blood, coagulation related indicators and blood transfusion volume were recorded. Results There was no statistical difference between the two groups in general information, related complications, in‑hospital mortality and death related complications (P>0.05). There was no statistical difference in the incidence of bleeding related events and thrombosis related events between the two groups (P>0.05). The TEG group showed decreases in heparin dosage, APTT ratio and R time, compared with the APTT group (P<0.05). The transfusion volume of erythrocytes and platelet in the TEG group was less than that in the APTT group (P<0.05). Conclusions During veno‑arterial ECMO (VA‑ECMO), it seems feasible to use TEG for anticoagulant management, compared with APTT, without increases the incidence of related malignant complications. The TEG group presents a low risk of bleeding and thrombosis and shows potential to reduce the amount of blood products during ECMO treatment.