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Hemostatic modulation with the liver dialysis device in humans with advanced liver disease
Magdalene M George1, David H Van Thiel, George Tarasuk
1Department of Medicine (Hepatology/Gastroenterology), Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA.
Background/Aims:
To determine the alterations in coagulation and fibrinolysis occurring in patients treated with the liver dialysis device.
Methodology:
Patients with advanced liver disease treated with the liver dialysis device were studied immediately before and after the liver dialysis device treatment.
Setting:
A university hospital intensive care unit.
Patients:
Thirteen consecutive patients with advanced liver disease being evaluated for or awaiting liver transplantation.
Intervention:
4-6 hours of liver dialysis treatment for management of hepatic encephalopathy.
Outcome Measures:
A panel of coagulation and anticoagulation factors, as well as fibrinolytic and anti-fibrinolytic factors plus measures of activation of inflammation and soluble adhesion factors.
Results:
The liver dialysis device used was found to be associated with activation of both coagulation and fibrinolytic pathways, activation of inflammation reactants, and an increase in sL-selectin levels.
Conclusions:
Liver dialysis device activates both coagulant and fibrinolytic pathways, activates inflammatory response, but these responses are limited to the vascular compartment by an increase in sL-selectin levels.