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Bleeding complications associated with the molecular adsorbent recirculating system: a retrospective study
Seon Woo Yoo1,2, Min-Jong Ki1,2, Dal Kim1
1Department of Anesthesiology and Pain Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea.
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.
Insights
The molecular adsorbent recirculating system (MARS) negatively impacts coagulation, increasing bleeding risk in liver failure patients. Low hemoglobin and altered clotting factors like Factor V are key risk factors for MARS-associated bleeding complications.
Area of Science:
- Hepatology
- Critical Care Medicine
- Hematology
Background:
- The molecular adsorbent recirculating system (MARS) is a form of artificial liver support for patients with liver failure.
- Bleeding complications are a frequent concern during or after MARS treatment.
- Understanding MARS's impact on coagulation is crucial for patient safety.
Purpose of the Study:
- To investigate how MARS affects blood coagulation.
- To identify specific factors that predict bleeding complications in patients undergoing MARS.
Main Methods:
- Retrospective analysis of 17 patients (41 MARS sessions).
- Comparison of pre- and post-MARS laboratory values (blood count, coagulation profiles, chemistry).
- Group comparison (bleeder vs. non-bleeder) based on pre-MARS laboratory values.
Main Results:
- MARS reduced bilirubin and creatinine but worsened coagulation by increasing prothrombin time and decreasing platelets and fibrinogen.
- Patients experiencing bleeding had significantly lower pre-MARS hemoglobin levels.
- Higher hemoglobin reduction during MARS correlated with lower pre-MARS PT-INR and Factor V levels.
Conclusions:
- MARS can alter coagulation factors (e.g., Factor V) and elevate bleeding risk, especially in patients with low hemoglobin.
- Pre-MARS low hemoglobin, PT-INR, and Factor V levels are associated with increased bleeding risk.
- Patient variability is significant, indicating a multifactorial risk profile for bleeding during MARS.
