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

The molecular adsorbent recirculating system (MARS) is a blood purification device with renal and hepatic dialytic effects. This study examined the use of low-dose unfractionated heparin in MARS. This was a prospective, observational study of 15 MARS treatment sessions (mean duration per treatment cycle = 12.2 +/- 4.5 h) in four patients with severe acute decompensation of chronic liver disease (n = 3) and fulminant hepatic failure (n = 1) treated with intermittent MARS. All patients were critically ill (APACHE II 24.8 +/- 3.3). Renal dialysis was with continuous hemofiltration and/or slow low-efficiency dialysis. One MARS session was terminated because of vascular access occlusion (1/15; 6.7%). Bleeding was noted in two sessions (2/15; 13%). Twelve MARS sessions were heparin-free and three treatments were with mean heparin dose of 833 +/- 382 IU. Serum biochemical parameters pre- and post-MARS were total bilirubin (micromol/L): 409.4 +/- 141.6 versus 282.9 +/- 90, P < 0.05; plasma ammonia (micromol/L): 44.3 +/- 21.2 versus 28.8 +/- 20.2, P = 0.002; urea (mmol/L): 15.9 +/- 11.8 versus 7.9 +/- 6.6, P = 0.002; creatinine (micromol/L): 252.4 +/- 151.9 versus 150.1 +/- 96.6, P = 0.003. Pre-MARS versus post-MARS systolic (SBPs) and diastolic (DBPs) blood pressures (mm Hg) were SBP = 129.2 +/- 27.7 versus 124 +/- 25, P = 0.838; and DBP = 60.7 +/- 15.3 versus 56 +/- 13, P = 0.595. Prothrombin time (PT), activated partial thromboplastin time (aPTT) and platelet count (Plt) pre- and post-MARS were PT(s): 22 +/- 7.9 versus 23.8 +/- 10.2, P = 0.116; aPTT (s): 64.5 +/- 40.9 versus 85.5 +/- 50.6, P = 0.092; and Plt (x10(3)/mm(3)): 87 +/- 67.6 versus 68.8 +/- 39, P = 0.098. MARS priming with heparin saline was safe. Heparin-minimized MARS did not compromise circuit function and longevity in extended intermittent MARS.

[1]  A. Davenport,et al.  Heparin‐induced thrombocytopenia: An uncommon but serious complication of heparin use in renal replacement therapy , 2006, Hemodialysis international. International Symposium on Home Hemodialysis.

[2]  C. Krenn,et al.  Molecular adsorbent recirculating system and hemostasis in patients at high risk of bleeding: an observational study , 2006, Critical Care.

[3]  I. Ahmad,et al.  Predictors of fatal outcome in fulminant hepatic failure. , 2006, Journal of the College of Physicians and Surgeons--Pakistan : JCPSP.

[4]  P. Nyckowski,et al.  The use Prometheus FPSA system in the treatment of acute liver failure: preliminary results. , 2006, Transplantation proceedings.

[5]  I. Marino,et al.  Fulminant Hepatic Failure Bridged to Liver Transplantation with a Molecular Adsorbent Recirculating System: A Single-Center Experience , 2006, Digestive Diseases and Sciences.

[6]  William M. Lee,et al.  Complications and use of intracranial pressure monitoring in patients with acute liver failure and severe encephalopathy , 2005, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[7]  V. Bhatia,et al.  Predictive value of arterial ammonia for complications and outcome in acute liver failure , 2005, Gut.

[8]  P. Berloco,et al.  One hundred sixteen cases of acute liver failure treated with MARS. , 2005, Transplantation proceedings.

[9]  J. Beaubien,et al.  FVIIa corrects the coagulopathy of fulminant hepatic failure but may be associated with thrombosis: A report of four cases , 2005, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[10]  H. Tan,et al.  Molecular adsorbent recirculating system (MARS). , 2004, Annals of the Academy of Medicine, Singapore.

[11]  R. Bellomo,et al.  Continuous Venovenous Hemofiltration Without Anticoagulation , 2004, ASAIO journal.

[12]  A. Gramowski,et al.  Improvement in Central Nervous System Functions During Treatment of Liver Failure with Albumin Dialysis MARS—A Review of Clinical, Biochemical, and Electrophysiological Data , 2002, Metabolic Brain Disease.

[13]  R. Bellomo,et al.  Solute mass balance during isovolaemic high volume haemofiltration , 2003, Intensive Care Medicine.

[14]  S. Morabito,et al.  Continuous renal replacement therapies: anticoagulation in the critically ill at high risk of bleeding. , 2003, Journal of nephrology.

[15]  R. Fluck,et al.  Characterization of treatment dose delivered by albumin dialysis in the treatment of acute renal failure associated with severe hepatic dysfunction. , 2002, Clinical nephrology.

[16]  D. Kelly.  Managing liver failure , 2002, Postgraduate medical journal.

[17]  J. Plummer,et al.  Conventional coagulation and thromboelastograph parameters and longevity of continuous renal replacement circuits , 2002, Intensive Care Medicine.

[18]  R. Bartlett,et al.  Results of a phase I trial evaluating a liver support device utilizing albumin dialysis. , 2001, Surgery.

[19]  T. Risler,et al.  Improvement of hepatorenal syndrome with extracorporeal albumin dialysis mars: Results of a prospective, randomized, controlled clinical trial , 2000, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[20]  A. Greenberg,et al.  Factors affecting system clotting in continuous renal replacement therapy: results of a randomized, controlled trial. , 2000, Clinical nephrology.

[21]  M. Löhr,et al.  Molecular adsorbent recycling system (MARS): clinical results of a new membrane-based blood purification system for bioartificial liver support. , 1999, Artificial organs.

[22]  S. Riordan,et al.  Fulminant hepatic failure , 2005, Transplantation.

[23]  A. Davenport,et al.  Comparison of the use of standard heparin and prostacyclin anticoagulation in spontaneous and pump-driven extracorporeal circuits in patients with combined acute renal and hepatic failure. , 1994, Nephron.