Thromboelastography to Monitor Clotting/Bleeding Complications in Patients Treated with the Molecular Adsorbent Recirculating System

Author:

Bachli Esther B.12,Bösiger Jörg3,Béchir Markus4,Stover John F.4,Stocker Reto4,Maggiorini Marco1,Renner Eberhard L.56,Müllhaupt Beat5,Schuepbach Reto A.14

Affiliation:

1. Medical Intensive Care Unit, University Hospital Zurich, 8091 Zurich, Switzerland

2. Clinic of Internal Medicine, Hospital Uster, 8610 Uster, Switzerland

3. Division of Haematology, University Hospital Zurich, 8091 Zurich, Switzerland

4. Surgical Intensive Care Unit, University Hospital Zurich, HOF-B-110, Raemistraße 100, 8091 Zurich, Switzerland

5. Division of Gastroenterology and Hepatology, University Hospital Zurich, 8091 Zurich, Switzerland

6. Multiorgan Transplant Program, University Health Network, University of Toronto, Toronto, ON M5G 2N2, Canada

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−1to 42 fL−1and 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.

Publisher

Hindawi Limited

Subject

Critical Care and Intensive Care Medicine

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