- Liver
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Bleeding complications associated with the molecular adsorbent recirculating system: a retrospective study
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Seon Woo Yoo, Min-Jong Ki, Dal Kim, Seul Ki Kim, SeungYong Park, Hyo Jin Han, Heung Bum Lee
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Acute Crit Care. 2021;36(4):322-331. Published online November 16, 2021
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DOI: https://doi.org/10.4266/acc.2021.00276
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 Abstract
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- Background
The molecular adsorbent recirculating system (MARS) is a hepatic replacement system that supports excretory liver function in patients with liver failure. However, since MARS has been employed in our hospital, bleeding complications have occurred in many patients during or after MARS. The objective of this study was to determine how MARS affects coagulopathy and identify specific factors associated with bleeding complications.
Methods
We retrospectively analyzed data from 17 patients undergoing a total of 41 MARS sessions. Complete blood count, coagulation profiles, and blood chemistry values were compared before and after MARS. To identify pre-MARS factors associated with increased bleeding after MARS, we divided patients into bleeder and non-bleeder groups and compared their pre-MARS laboratory values.
Results
MARS significantly reduced bilirubin and creatinine levels. MARS also increased prothrombin time and reduced platelet and fibrinogen, thus negatively impacting coagulation. Pre-MARS hemoglobin was significantly lower in the bleeder group than in the non-bleeder group (P=0.015). When comparing the upper and lower 33% of MARS sessions based on the hemoglobin reduction rate, hemoglobin reduction was significantly greater in MARS sessions involving patients with low pre-MARS international normalized ratio of prothrombin time (PT-INR) and factor V (P=0.038 and P=0.023, respectively).
Conclusions
MARS could appears to alter coagulation-related factors such as factor V and increase the risk of bleeding complications particularly in patient with low hemoglobin. However, individual differences among patients were large, and various factors, such as low hemoglobin, PT-INR, and factor V levels, appear to be involved.
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Citations
Citations to this article as recorded by  - Crosslinked Bifunctional Particles for the Removal of Bilirubin in Hyperbilirubinemia Cases
María del Prado Garrido, Ana Maria Borreguero, Maria Jesús Ramos, Manuel Carmona, Francisco Javier Redondo Calvo, Juan Francisco Rodriguez
Materials.2023; 16(8): 2999. CrossRef - The Effect of Molecular Adsorbent Recirculating System in Patients With Liver Failure: A Case Series of 44 Patients
Shahin Isha, Anna S. Jenkins, Abby J. Hanson, Parthkumar H. Satashia, Sai Abhishek Narra, Gunjan D. Mundhra, Mohammed Mustafa Hasan, Ashrita Donepudi, Abishek Giri, Patrick W. Johnson, Dolores Villar, Christan Santos, Juan Canabal, Philip Lowman, Pablo Mo
Transplantation Proceedings.2023; 55(9): 2126. CrossRef - Fractionated plasma separation and adsorption integrated with continuous veno‐venous hemofiltration in patients with acute liver failure: A single center experience from China
Jianhua Dong, Li Huang, Chuan Li, Bian Wu, Xi Yang, Yongchun Ge
Journal of Clinical Apheresis.2023;[Epub] CrossRef - Extracorporeal organ support and the kidney
Maria-Jimena Muciño-Bermejo
Frontiers in Nephrology.2022;[Epub] CrossRef
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