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Critical Care 2005
Molecular adsorbent recirculating system and hemostasis in patients at high risk of bleeding: an observational studyDOI: 10.1186/cc3985 Abstract: We studied 61 MARS treatments in 33 patients with acute liver failure (n = 15), acute-on-chronic liver failure (n = 8), sepsis (n = 5), liver graft dysfunction (n = 3), and cholestasis (n = 2). Standard coagulation tests, standard thromboelastography (TEG), and heparinase-modified and abciximab-fab-modified TEG were performed immediately before and 30 minutes after commencement of MARS, and after the end of MARS treatment. Prostaglandin I2 was administered extracorporeally to all patients; 17 patients additionally received unfractioned heparin.Three moderate bleeding complications in three patients, requiring three to four units of packed red blood cells, were observed. All were sufficiently managed without interrupting MARS treatment. Although there was a significant decrease in platelet counts (median, 9 G/l; range, -40 to 145 G/l) and fibrinogen concentration (median, 15 mg/dl; range, -119 to 185 mg/dl) with a consecutive increase in thrombin time, the platelet function, as assessed by abciximab-fab-modified TEG, remained stable. MARS did not enhance fibrinolysis.MARS treatment appears to be well tolerated during marked coagulopathy due to liver failure. Although MARS leads to a further decrease in platelet count and fibrinogen concentration, platelet function, measured as the contribution of the platelets to the clot firmness in TEG, remains stable. According to TEG-based results, MARS does not enhance fibrinolysis.The molecular adsorbent recirculating system (MARS) has been developed and successfully used in patients with liver failure to replace excretory liver function and detoxification. MARS is based on principles of albumin dialysis, and was shown to significantly improve hepatic encephalopathy, cerebral blood flow, renal function, and systemic hemodynamics [1-3]. It has further been shown that plasma concentrations of ammonia and many albumin-bound molecules, such as bilirubin, decreased during MARS therapy [4,5]. Nevertheless, improved outcome has been d
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