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Thromboelastography to monitor clotting/bleeding complications in patients treated with the molecular adsorbent recirculating system.

Bachli EB, Bösiger J, Béchir M, Stover JF, Stocker R, Maggiorini M, Renner EL, Müllhaupt B, Schuepbach RA - Crit Care Res Pract (2011)

Bottom Line: We hypothesized that monitoring clotting parameters and bed-side thromboelastography allows to reduce bleeding complications.Methods.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Medical Intensive Care Unit, University Hospital Zurich, 8091 Zurich, Switzerland.

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.

No MeSH data available.


Related in: MedlinePlus

MARS therapy efficiently clears serum creatinin and bilirubin. Evolution of the parameters serum creatinin and bilirubin during MARS therapy. Each line represents a pair of values from an individual MARS treatment session. Gray dots represent values from uneventful MARS session, black open circles sessions complicated by device clotting and black triangles sessions with bleeding complications. Closed black circles connected by a thick black line indicate mean values. Significant P values are indicated, sessions analysed (n = 25), of which (n = 16) were uneventful, (n = 3) were complicated by bleeding and (n = 6) by clotting of the MARS filter system.
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Related In: Results  -  Collection


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fig2: MARS therapy efficiently clears serum creatinin and bilirubin. Evolution of the parameters serum creatinin and bilirubin during MARS therapy. Each line represents a pair of values from an individual MARS treatment session. Gray dots represent values from uneventful MARS session, black open circles sessions complicated by device clotting and black triangles sessions with bleeding complications. Closed black circles connected by a thick black line indicate mean values. Significant P values are indicated, sessions analysed (n = 25), of which (n = 16) were uneventful, (n = 3) were complicated by bleeding and (n = 6) by clotting of the MARS filter system.

Mentions: Serum concentrations of creatinin, bilirubin arterial ammonium and CRP were determined before and after each MARS session. As reported previously, serum creatinin and bilirubin were significantly cleared by MARS (Figure 2) [8]. Serum ammonia and CRP were unaffected by MARS (not shown).


Thromboelastography to monitor clotting/bleeding complications in patients treated with the molecular adsorbent recirculating system.

Bachli EB, Bösiger J, Béchir M, Stover JF, Stocker R, Maggiorini M, Renner EL, Müllhaupt B, Schuepbach RA - Crit Care Res Pract (2011)

MARS therapy efficiently clears serum creatinin and bilirubin. Evolution of the parameters serum creatinin and bilirubin during MARS therapy. Each line represents a pair of values from an individual MARS treatment session. Gray dots represent values from uneventful MARS session, black open circles sessions complicated by device clotting and black triangles sessions with bleeding complications. Closed black circles connected by a thick black line indicate mean values. Significant P values are indicated, sessions analysed (n = 25), of which (n = 16) were uneventful, (n = 3) were complicated by bleeding and (n = 6) by clotting of the MARS filter system.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3064997&req=5

fig2: MARS therapy efficiently clears serum creatinin and bilirubin. Evolution of the parameters serum creatinin and bilirubin during MARS therapy. Each line represents a pair of values from an individual MARS treatment session. Gray dots represent values from uneventful MARS session, black open circles sessions complicated by device clotting and black triangles sessions with bleeding complications. Closed black circles connected by a thick black line indicate mean values. Significant P values are indicated, sessions analysed (n = 25), of which (n = 16) were uneventful, (n = 3) were complicated by bleeding and (n = 6) by clotting of the MARS filter system.
Mentions: Serum concentrations of creatinin, bilirubin arterial ammonium and CRP were determined before and after each MARS session. As reported previously, serum creatinin and bilirubin were significantly cleared by MARS (Figure 2) [8]. Serum ammonia and CRP were unaffected by MARS (not shown).

Bottom Line: We hypothesized that monitoring clotting parameters and bed-side thromboelastography allows to reduce bleeding complications.Methods.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Medical Intensive Care Unit, University Hospital Zurich, 8091 Zurich, Switzerland.

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.

No MeSH data available.


Related in: MedlinePlus