Molecular adsorbent recirculating system and hemostasis in patients at high risk of bleeding: an observational study.
BACKGROUND
Liver failure is associated with reduced synthesis of clotting factors, consumptive coagulopathy, and platelet dysfunction. The aim of the study was to evaluate the effects of liver support using a molecular adsorbent recirculating system (MARS) on the coagulation system in patients at high risk of bleeding.


METHODS
We studied 61 MARS treatments in 33 patients with acute liver failure (n = 15), acute-on-chronic liver failure (n = 8), sepsis (n = 5), liver graft dysfunction (n = 3), and cholestasis (n = 2). Standard coagulation tests, standard thromboelastography (TEG), and heparinase-modified and abciximab-fab-modified TEG were performed immediately before and 30 minutes after commencement of MARS, and after the end of MARS treatment. Prostaglandin I2 was administered extracorporeally to all patients; 17 patients additionally received unfractioned heparin.


RESULTS
Three moderate bleeding complications in three patients, requiring three to four units of packed red blood cells, were observed. All were sufficiently managed without interrupting MARS treatment. Although there was a significant decrease in platelet counts (median, 9 G/l; range, -40 to 145 G/l) and fibrinogen concentration (median, 15 mg/dl; range, -119 to 185 mg/dl) with a consecutive increase in thrombin time, the platelet function, as assessed by abciximab-fab-modified TEG, remained stable. MARS did not enhance fibrinolysis.


CONCLUSIONS
MARS treatment appears to be well tolerated during marked coagulopathy due to liver failure. Although MARS leads to a further decrease in platelet count and fibrinogen concentration, platelet function, measured as the contribution of the platelets to the clot firmness in TEG, remains stable. According to TEG-based results, MARS does not enhance fibrinolysis.
Department of Anesthesiology and General Intensive Care, Medical University of Vienna, Austria. peter.faybik@meduniwien.ac.at
Peter
P
Faybik
Andreas
A
Bacher
Sibylle A
SA
Kozek-Langenecker
Heinz
H
Steltzer
Claus Georg
CG
Krenn
Sandra
S
Unger
Hubert
H
Hetz
D000293:Adolescent; D000327:Adsorption; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006470:Hemorrhage / Q000097:blood* / Q000209:etiology / Q000628:therapy*; D006487:Hemostasis / Q000502:physiology*; D006801:Humans; D017093:Liver Failure / Q000097:blood / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016060:Sorption Detoxification / Q000379:methods*