Anticoagulation Minimization Is Safe and Effective in Albumin Liver Dialysis Using the Molecular Adsorbent Recirculating System

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Abstract

The molecular adsorbent recirculating system (MARS) is a blood purification device with renal and hepatic dialytic effects. This study examined the use of low-dose unfractionated heparin in MARS. This was a prospective, observational study of 15 MARS treatment sessions (mean duration per treatment cycle = 12.2 ± 4.5 h) in four patients with severe acute decompensation of chronic liver disease (n = 3) and fulminant hepatic failure (n = 1) treated with intermittent MARS. All patients were critically ill (APACHE II 24.8 ± 3.3). Renal dialysis was with continuous hemofiltration and/or slow low-efficiency dialysis. One MARS session was terminated because of vascular access occlusion (1/15; 6.7%). Bleeding was noted in two sessions (2/15; 13%). Twelve MARS sessions were heparin-free and three treatments were with mean heparin dose of 833 ± 382 IU. Serum biochemical parameters pre- and post-MARS were total bilirubin (μmol/L): 409.4 ± 141.6 versus 282.9 ± 90, P < 0.05; plasma ammonia (μmol/L): 44.3 ± 21.2 versus 28.8 ± 20.2, P = 0.002; urea (mmol/L): 15.9 ± 11.8 versus 7.9 ± 6.6, P = 0.002; creatinine (μmol/L): 252.4 ± 151.9 versus 150.1 ± 96.6, P = 0.003. Pre-MARS versus post-MARS systolic (SBPs) and diastolic (DBPs) blood pressures (mm Hg) were SBP = 129.2 ± 27.7 versus 124 ± 25, P = 0.838; and DBP = 60.7 ± 15.3 versus 56 ± 13, P = 0.595. Prothrombin time (PT), activated partial thromboplastin time (aPTT) and platelet count (Plt) pre- and post-MARS were PT(s): 22 ± 7.9 versus 23.8 ± 10.2, P = 0.116; aPTT (s): 64.5 ± 40.9 versus 85.5 ± 50.6, P = 0.092; and Plt (×103/mm3): 87 ± 67.6 versus 68.8 ± 39, P = 0.098. MARS priming with heparin saline was safe. Heparin-minimized MARS did not compromise circuit function and longevity in extended intermittent MARS.

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