title: Thromboelastography to monitor clotting/bleeding complications in patients treated with the molecular adsorbent recirculating system.
abstract: Background. The Molecular Adsorbent Recirculating System (MARS) has been shown to clear albumin-bound toxins from patients with liver failure but might cause bleeding complications potentially obscuring survival benefits. We hypothesized that monitoring clotting parameters and bed-side thromboelastography allows to reduce bleeding complications. Methods. Retrospective analysis of 25 MARS sessions during which clotting parameters were monitored by a standardized protocol. Results. During MARS therapy median INR increased significantly from 1.7 to 1.9 platelet count and fibrinogen content decreased significantly from 57 fL(-1) to 42 fL(-1) and 2.1 g/L to 1.5 g/L. Nine relevant complications occurred: the MARS system clotted 6 times 3 times we observed hemorrhages. Absent thrombocytopenia and elevated plasma fibrinogen predicted clotting of the MARS system (ROC 0.94 and 0.82). Fibrinolysis, detected by thromboelastography, uniquely predicted bleeding events. Conclusion. Bed-side thromboelastography and close monitoring of coagulation parameters can predict and, therefore, help prevent bleeding complications during MARS therapy.
authors.affiliation: Medical Intensive Care Unit, University Hospital Zurich, 8091 Zurich, Switzerland.
authors.forename: Esther B
authors.initials: EB
authors.lastname: Bachli
authors.forename: Jörg
authors.initials: J
authors.lastname: Bösiger
authors.forename: Markus
authors.initials: M
authors.lastname: Béchir
authors.forename: John F
authors.initials: JF
authors.lastname: Stover
authors.forename: Reto
authors.initials: R
authors.lastname: Stocker
authors.forename: Marco
authors.initials: M
authors.lastname: Maggiorini
authors.forename: Eberhard L
authors.initials: EL
authors.lastname: Renner
authors.forename: Beat
authors.initials: B
authors.lastname: Müllhaupt
authors.forename: Reto A
authors.initials: RA
authors.lastname: Schuepbach