Limits...
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

No indication for activation of the clotting system by MARS: From a subset of MARS sessions (patient no. 2 and no. 4) frozen plasma samples were available and parameters for thrombin activation were determined. (a) Quantification of F1+2 fragments by ELISA in plasma samples obtained before (prior) during and after the MARS sessions, are presented as box plots. Baseline F1+2 values were significantly above the cut-off value of 1.2 nmol/L (P < .05). MARS therapy did not significantly influence F1+2 values over time. (b) Estimation of the endogenous thrombin potential. Samples were as in (a). Line plots present data as mean ± SD for the parameters lag time, endogenous thrombin potential (ETP), maximal response (peak) and the time until the peak is reached (time to peak), n = 8, *Indicates P < .05.
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3064997&req=5

fig6: No indication for activation of the clotting system by MARS: From a subset of MARS sessions (patient no. 2 and no. 4) frozen plasma samples were available and parameters for thrombin activation were determined. (a) Quantification of F1+2 fragments by ELISA in plasma samples obtained before (prior) during and after the MARS sessions, are presented as box plots. Baseline F1+2 values were significantly above the cut-off value of 1.2 nmol/L (P < .05). MARS therapy did not significantly influence F1+2 values over time. (b) Estimation of the endogenous thrombin potential. Samples were as in (a). Line plots present data as mean ± SD for the parameters lag time, endogenous thrombin potential (ETP), maximal response (peak) and the time until the peak is reached (time to peak), n = 8, *Indicates P < .05.

Mentions: To further explore the potential underlying mechanism driving clotting complications during MARS therapy we retrospectively quantified F1+2 peptide fragments. These activation peptides are generated upon the conversion of prothrombin into thrombin and serve as marker for thrombin generation. Baseline F1+2 were elevated and found to slightly decrease under MARS therapy (Figure 6(a)).


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)

No indication for activation of the clotting system by MARS: From a subset of MARS sessions (patient no. 2 and no. 4) frozen plasma samples were available and parameters for thrombin activation were determined. (a) Quantification of F1+2 fragments by ELISA in plasma samples obtained before (prior) during and after the MARS sessions, are presented as box plots. Baseline F1+2 values were significantly above the cut-off value of 1.2 nmol/L (P < .05). MARS therapy did not significantly influence F1+2 values over time. (b) Estimation of the endogenous thrombin potential. Samples were as in (a). Line plots present data as mean ± SD for the parameters lag time, endogenous thrombin potential (ETP), maximal response (peak) and the time until the peak is reached (time to peak), n = 8, *Indicates P < .05.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig6: No indication for activation of the clotting system by MARS: From a subset of MARS sessions (patient no. 2 and no. 4) frozen plasma samples were available and parameters for thrombin activation were determined. (a) Quantification of F1+2 fragments by ELISA in plasma samples obtained before (prior) during and after the MARS sessions, are presented as box plots. Baseline F1+2 values were significantly above the cut-off value of 1.2 nmol/L (P < .05). MARS therapy did not significantly influence F1+2 values over time. (b) Estimation of the endogenous thrombin potential. Samples were as in (a). Line plots present data as mean ± SD for the parameters lag time, endogenous thrombin potential (ETP), maximal response (peak) and the time until the peak is reached (time to peak), n = 8, *Indicates P < .05.
Mentions: To further explore the potential underlying mechanism driving clotting complications during MARS therapy we retrospectively quantified F1+2 peptide fragments. These activation peptides are generated upon the conversion of prothrombin into thrombin and serve as marker for thrombin generation. Baseline F1+2 were elevated and found to slightly decrease under MARS therapy (Figure 6(a)).

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