title: Anticoagulation minimization is safe and effective in albumin liver dialysis using the molecular adsorbent recirculating system.
abstract: The molecular adsorbent recirculating system (MARS) is a blood purification device with renal and hepatic dialytic effects. This study examined the use of low-dose unfractionated heparin in MARS. This was a prospective, observational study of 15 MARS treatment sessions (mean duration per treatment cycle = 12.2 +/- 4.5 h) in four patients with severe acute decompensation of chronic liver disease (n = 3) and fulminant hepatic failure (n = 1) treated with intermittent MARS. All patients were critically ill (APACHE II 24.8 +/- 3.3). Renal dialysis was with continuous hemofiltration and/or slow low-efficiency dialysis. One MARS session was terminated because of vascular access occlusion (1/15; 6.7%). Bleeding was noted in two sessions (2/15; 13%). Twelve MARS sessions were heparin-free and three treatments were with mean heparin dose of 833 +/- 382 IU. Serum biochemical parameters pre- and post-MARS were total bilirubin (micromol/L): 409.4 +/- 141.6 versus 282.9 +/- 90, P < 0.05; plasma ammonia (micromol/L): 44.3 +/- 21.2 versus 28.8 +/- 20.2, P = 0.002; urea (mmol/L): 15.9 +/- 11.8 versus 7.9 +/- 6.6, P = 0.002; creatinine (micromol/L): 252.4 +/- 151.9 versus 150.1 +/- 96.6, P = 0.003. Pre-MARS versus post-MARS systolic (SBPs) and diastolic (DBPs) blood pressures (mm Hg) were SBP = 129.2 +/- 27.7 versus 124 +/- 25, P = 0.838; and DBP = 60.7 +/- 15.3 versus 56 +/- 13, P = 0.595. Prothrombin time (PT), activated partial thromboplastin time (aPTT) and platelet count (Plt) pre- and post-MARS were PT(s): 22 +/- 7.9 versus 23.8 +/- 10.2, P = 0.116; aPTT (s): 64.5 +/- 40.9 versus 85.5 +/- 50.6, P = 0.092; and Plt (x10(3)/mm(3)): 87 +/- 67.6 versus 68.8 +/- 39, P = 0.098. MARS priming with heparin saline was safe. Heparin-minimized MARS did not compromise circuit function and longevity in extended intermittent MARS.
authors.affiliation: Department of Renal Medicine, Singapore General Hospital, Outram Road, Singapore 169608. grmthk@sgh.com.sg
authors.forename: Han Khim
authors.initials: HK
authors.lastname: Tan
authors.forename: Wen Shin
authors.initials: WS
authors.lastname: Yang
authors.forename: Pierce
authors.initials: P
authors.lastname: Chow
authors.forename: Hock Foong
authors.initials: HF
authors.lastname: Lui
authors.forename: Hui Lin
authors.initials: HL
authors.lastname: Choong
authors.forename: Kok Seng
authors.initials: KS
authors.lastname: Wong
mesh_terms: D000368:Aged; D000418:Albumins / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D017583:Hemodiafiltration / Q000379:methods*; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D017114:Liver Failure, Acute / Q000628:therapy*; D019164:Liver, Artificial; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D000418:Albumins; D000925:Anticoagulants; D006493:Heparin