Acute Crit Care.  2021 Nov;36(4):322-331. 10.4266/acc.2021.00276.

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

• Yoo SW
• Ki MJ
• Kim D
• Kim SK
• Park S
• Han HJ
• Lee HB

• KMID: 2524315
• DOI: http://doi.org/10.4266/acc.2021.00276

Abstract

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.

Keyword

acute liver failure; bleeding complication; coagulopathy; extracorporeal liver support; molecular adsorbent recirculating system; liver cirrhosis

Figure

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  Figure 1. Sequential measurements of coagulation factors (n=27). All factors (factor II, V, VII, and X) decreased significantly over time (P=0.012, P<0.001, P=0.001, and P=0.002, respectively). Note that factor V sharply decreased from 30.1% before molecular adsorbent recirculating system (MARS) to 25.8% and 21.9%, respectively, 2 hours after MARS started and after MARS finished.

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