Bleeding complications associated with the molecular adsorbent recirculating system: a retrospective study

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.