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Critical Care Research and Practice
Volume 2011, Article ID 313854, 10 pages
http://dx.doi.org/10.1155/2011/313854
Clinical Study

Thromboelastography to Monitor Clotting/Bleeding Complications in Patients Treated with the Molecular Adsorbent Recirculating System

1Medical Intensive Care Unit, University Hospital Zurich, 8091 Zurich, Switzerland
2Clinic of Internal Medicine, Hospital Uster, 8610 Uster, Switzerland
3Division of Haematology, University Hospital Zurich, 8091 Zurich, Switzerland
4Surgical Intensive Care Unit, University Hospital Zurich, HOF-B-110, Raemistraße 100, 8091 Zurich, Switzerland
5Division of Gastroenterology and Hepatology, University Hospital Zurich, 8091 Zurich, Switzerland
6Multiorgan Transplant Program, University Health Network, University of Toronto, Toronto, ON M5G 2N2, Canada

Received 10 November 2010; Accepted 13 January 2011

Academic Editor: Ali A. El Solh

Copyright © 2011 Esther B. Bachli et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. The Molecular Adsorbent Recirculating System (MARS) has been shown to clear albumin-bound toxins from patients with liver failure but might cause bleeding complications potentially obscuring survival benefits. We hypothesized that monitoring clotting parameters and bed-side thromboelastography allows to reduce bleeding complications. Methods. Retrospective analysis of 25 MARS sessions during which clotting parameters were monitored by a standardized protocol. Results. During MARS therapy median INR increased significantly from 1.7 to 1.9 platelet count and fibrinogen content decreased significantly from 57 fL−1 to 42 fL−1 and 2.1 g/L to 1.5 g/L. Nine relevant complications occurred: the MARS system clotted 6 times 3 times we observed hemorrhages. Absent thrombocytopenia and elevated plasma fibrinogen predicted clotting of the MARS system (ROC 0.94 and 0.82). Fibrinolysis, detected by thromboelastography, uniquely predicted bleeding events. Conclusion. Bed-side thromboelastography and close monitoring of coagulation parameters can predict and, therefore, help prevent bleeding complications during MARS therapy.