Thromboelastography to Monitor Clotting/Bleeding Complications in Patients Treated with the Molecular Adsorbent Recirculating System
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 thromboelasto...
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| Format: | Article |
| Language: | English |
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Wiley
2011-01-01
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| Series: | Critical Care Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2011/313854 |
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| author | Esther B. Bachli Jörg Bösiger Markus Béchir John F. Stover Reto Stocker Marco Maggiorini Eberhard L. Renner Beat Müllhaupt Reto A. Schuepbach |
| author_facet | Esther B. Bachli Jörg Bösiger Markus Béchir John F. Stover Reto Stocker Marco Maggiorini Eberhard L. Renner Beat Müllhaupt Reto A. Schuepbach |
| author_sort | Esther B. Bachli |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-b601cc1ca66e4397a3c86ac1e8b2e644 |
| institution | Kabale University |
| issn | 2090-1305 2090-1313 |
| language | English |
| publishDate | 2011-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Critical Care Research and Practice |
| spelling | doaj-art-b601cc1ca66e4397a3c86ac1e8b2e6442025-02-03T06:44:21ZengWileyCritical Care Research and Practice2090-13052090-13132011-01-01201110.1155/2011/313854313854Thromboelastography to Monitor Clotting/Bleeding Complications in Patients Treated with the Molecular Adsorbent Recirculating SystemEsther B. Bachli0Jörg Bösiger1Markus Béchir2John F. Stover3Reto Stocker4Marco Maggiorini5Eberhard L. Renner6Beat Müllhaupt7Reto A. Schuepbach8Medical Intensive Care Unit, University Hospital Zurich, 8091 Zurich, SwitzerlandDivision of Haematology, University Hospital Zurich, 8091 Zurich, SwitzerlandSurgical Intensive Care Unit, University Hospital Zurich, HOF-B-110, Raemistraße 100, 8091 Zurich, SwitzerlandSurgical Intensive Care Unit, University Hospital Zurich, HOF-B-110, Raemistraße 100, 8091 Zurich, SwitzerlandSurgical Intensive Care Unit, University Hospital Zurich, HOF-B-110, Raemistraße 100, 8091 Zurich, SwitzerlandMedical Intensive Care Unit, University Hospital Zurich, 8091 Zurich, SwitzerlandDivision of Gastroenterology and Hepatology, University Hospital Zurich, 8091 Zurich, SwitzerlandDivision of Gastroenterology and Hepatology, University Hospital Zurich, 8091 Zurich, SwitzerlandMedical Intensive Care Unit, University Hospital Zurich, 8091 Zurich, SwitzerlandBackground. 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.http://dx.doi.org/10.1155/2011/313854 |
| spellingShingle | Esther B. Bachli Jörg Bösiger Markus Béchir John F. Stover Reto Stocker Marco Maggiorini Eberhard L. Renner Beat Müllhaupt Reto A. Schuepbach Thromboelastography to Monitor Clotting/Bleeding Complications in Patients Treated with the Molecular Adsorbent Recirculating System Critical Care Research and Practice |
| title | Thromboelastography to Monitor Clotting/Bleeding Complications in Patients Treated with the Molecular Adsorbent Recirculating System |
| title_full | Thromboelastography to Monitor Clotting/Bleeding Complications in Patients Treated with the Molecular Adsorbent Recirculating System |
| title_fullStr | Thromboelastography to Monitor Clotting/Bleeding Complications in Patients Treated with the Molecular Adsorbent Recirculating System |
| title_full_unstemmed | Thromboelastography to Monitor Clotting/Bleeding Complications in Patients Treated with the Molecular Adsorbent Recirculating System |
| title_short | Thromboelastography to Monitor Clotting/Bleeding Complications in Patients Treated with the Molecular Adsorbent Recirculating System |
| title_sort | thromboelastography to monitor clotting bleeding complications in patients treated with the molecular adsorbent recirculating system |
| url | http://dx.doi.org/10.1155/2011/313854 |
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