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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

High plasma fibrinogen concentration and lack of thrombocytopenia at baseline predict clotting within the MARS filter system. (a) Baseline fibrinogen concentrations and platelet counts from individual sessions were grouped into sessions without event (uneventful), complicated by bleeding episodes and complicated by clotting events within the MARS filter system. (b) Receiver operator curve of baseline plasma fibrinogen concentration and platelet count for prediction of MARS filter clotting events. Significant P values are indicated, AUCROC = 0.94 (CI95% 0.74 to 0.99) for fibrinogen, 0.82 (CI95% 0.5 to 0.95) for platelets, respectively, 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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fig3: High plasma fibrinogen concentration and lack of thrombocytopenia at baseline predict clotting within the MARS filter system. (a) Baseline fibrinogen concentrations and platelet counts from individual sessions were grouped into sessions without event (uneventful), complicated by bleeding episodes and complicated by clotting events within the MARS filter system. (b) Receiver operator curve of baseline plasma fibrinogen concentration and platelet count for prediction of MARS filter clotting events. Significant P values are indicated, AUCROC = 0.94 (CI95% 0.74 to 0.99) for fibrinogen, 0.82 (CI95% 0.5 to 0.95) for platelets, respectively, 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: In order to explore predictors for bleeding or clotting events during MARS, we compared various coagulation parameters prior to sessions with and without events. None of the parameters analysed at baseline (INR, aPTT, TT, fibrinogen content, D-dimer, platelet count, CT, CFT, MCF, or Lys 60′) were significantly associated with developing bleeding complications. In contrast, fibrinogen content and platelet counts were significantly higher prior to sessions that were later complicated by MARS filter clotting (Figure 3(a)). The predictive value of a parameter can be estimated by calculation of the area under the curve (AUC) in receiver operator curves (ROC). AUCROC were found to be 0.94 for fibrinogen and 0.82 for platelets (Figure 3(b)). In our cohort, a fibrinogen content of 2.5 g/L or more was found to predict filter clotting with 100% sensitivity and 80% specificity. Platelet counts exceeding 150 fL−1 still had a 80% sensitivity and a specificity of 80%.


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)

High plasma fibrinogen concentration and lack of thrombocytopenia at baseline predict clotting within the MARS filter system. (a) Baseline fibrinogen concentrations and platelet counts from individual sessions were grouped into sessions without event (uneventful), complicated by bleeding episodes and complicated by clotting events within the MARS filter system. (b) Receiver operator curve of baseline plasma fibrinogen concentration and platelet count for prediction of MARS filter clotting events. Significant P values are indicated, AUCROC = 0.94 (CI95% 0.74 to 0.99) for fibrinogen, 0.82 (CI95% 0.5 to 0.95) for platelets, respectively, 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

fig3: High plasma fibrinogen concentration and lack of thrombocytopenia at baseline predict clotting within the MARS filter system. (a) Baseline fibrinogen concentrations and platelet counts from individual sessions were grouped into sessions without event (uneventful), complicated by bleeding episodes and complicated by clotting events within the MARS filter system. (b) Receiver operator curve of baseline plasma fibrinogen concentration and platelet count for prediction of MARS filter clotting events. Significant P values are indicated, AUCROC = 0.94 (CI95% 0.74 to 0.99) for fibrinogen, 0.82 (CI95% 0.5 to 0.95) for platelets, respectively, 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: In order to explore predictors for bleeding or clotting events during MARS, we compared various coagulation parameters prior to sessions with and without events. None of the parameters analysed at baseline (INR, aPTT, TT, fibrinogen content, D-dimer, platelet count, CT, CFT, MCF, or Lys 60′) were significantly associated with developing bleeding complications. In contrast, fibrinogen content and platelet counts were significantly higher prior to sessions that were later complicated by MARS filter clotting (Figure 3(a)). The predictive value of a parameter can be estimated by calculation of the area under the curve (AUC) in receiver operator curves (ROC). AUCROC were found to be 0.94 for fibrinogen and 0.82 for platelets (Figure 3(b)). In our cohort, a fibrinogen content of 2.5 g/L or more was found to predict filter clotting with 100% sensitivity and 80% specificity. Platelet counts exceeding 150 fL−1 still had a 80% sensitivity and a specificity of 80%.

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