1. Thromboelastography to monitor clotting/bleeding complications in patients treated with the molecular adsorbent recirculating system.
- Author
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Bachli, Esther B., B¨osiger, J¨org, B´echir, Markus, Stover, John F., Stocker, Reto, Maggiorini, Marco, Renner, Eberhard L., M¨ullhaupt, Beat, Schuepbach, Reto A., Bösiger, Jörg, Béchir, Markus, and Müllhaupt, Beat
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THROMBOLYTIC therapy , *FIBRINOLYSIS , *HEMORRHAGE complications , *RETROSPECTIVE studies , *TREATMENT effectiveness , *MEDICAL protocols , *FIBRINOGEN , *BLOOD coagulation - 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. [ABSTRACT FROM AUTHOR]
- Published
- 2011
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