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Anticoagulation minimization is safe and effective in albumin liver dialysis using the molecular adsorbent

Han Khim Tan1, Wen Shin Yang, Pierce Chow

  • 1Department of Renal Medicine, Singapore General Hospital, Outram Road, Singapore 169608. grmthk@sgh.com.sg

Artificial Organs
|March 9, 2007
PubMed

Insights

Low-dose heparin in molecular adsorbent recirculating system (MARS) treatments for liver failure was safe and effective. This blood purification method showed significant improvements in liver function markers without compromising the MARS circuit.

Area of Science:

  • Nephrology
  • Hepatology
  • Critical Care Medicine

Background:

  • The molecular adsorbent recirculating system (MARS) is a vital blood purification technology for patients with severe liver dysfunction.
  • Heparin is commonly used to prevent clotting in extracorporeal circuits, but its use can increase bleeding risk in critically ill patients.

Purpose of the Study:

  • To evaluate the safety and efficacy of using low-dose unfractionated heparin during intermittent MARS treatments in critically ill patients with liver failure.
  • To assess the impact of heparin-minimized MARS on circuit function and longevity.

Main Methods:

  • A prospective, observational study involving 15 MARS treatment sessions in four patients with severe acute decompensation of chronic liver disease or fulminant hepatic failure.
  • MARS treatments included continuous hemofiltration and/or slow low-efficiency dialysis.
  • Data collected included serum biochemical parameters, blood pressure, prothrombin time, activated partial thromboplastin time, and platelet count pre- and post-MARS.

Main Results:

  • MARS priming with heparin saline was safe, with only one session terminated due to vascular access occlusion and bleeding noted in two sessions (13%).
  • Significant reductions were observed in total bilirubin (P < 0.05), plasma ammonia (P = 0.002), urea (P = 0.002), and creatinine (P = 0.003) post-MARS.
  • Heparin-minimized MARS did not compromise circuit function or longevity during extended intermittent treatments.

Conclusions:

  • Low-dose unfractionated heparin can be safely used in MARS treatments for patients with severe liver failure.
  • Heparin-minimized MARS effectively improves key biochemical markers associated with liver dysfunction.
  • This approach offers a viable alternative for anticoagulation in MARS, potentially reducing bleeding complications.

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