Thromboelastography used to assess coagulation during treatment with molecular adsorbent recirculating system

Cataldo Doria, Lucio Mandalà, Jan D. Smith, Giuseppe Carauna, Victor L. Scott, Salvatore Gruttadauria, Mario Magnone, Ignazio R. Marino

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Coagulopathy is a life-threatening complication of liver cirrhosis. We describe the effect of molecular adsorbent recirculating system (MARS), a cell-free dialysis technique, on the blood coagulation of cirrhotic patients. From February 2002 to July 2002, nine patients - five males (55.5%) and four females (44.4%), age 47-70 yr (median 56) - underwent 12 courses (4-7 sessions each) of MARS. Patients were treated for the following indications: six (66.6%) acute-on-chronic hepatic failure, three (33.3%) intractable pruritus. Platelet count, prothrombin time (PT), international standardized ratio and thromboelastography were measured before and after each MARS session. Coagulation factors II, V, VII, VIII, IX, X, XI, XII, XIII, von Willebrand, lupus anticoagulant, protein C, protein S, antithrombin III, plasminogen, α2 antiplasmin, D-dimer, fibrin monomers, complement, and C1, inactivator were measured before and at the end of each MARS treatment. We found a statistically significant difference (p <0.05) in the platelet count, PT, all the thromboelastograph variables (reaction and constant time, α angle, and maximal amplitude), factor VIII, von Willebrand, and D-dimer, when measured before and after MARS. Previous reports have shown amelioration of blood coagulation following MARS treatments. However, we document that MARS induces coagulopathy through a platelet-mediated mechanism, whereby platelet may be mechanically destroyed during the passage of blood through the filters and lines. An alternative postulated mechanism is an immune-mediated platelet disruption - coagulopathy.

Original languageEnglish
Pages (from-to)365-371
Number of pages7
JournalClinical Transplantation
Issue number4
Publication statusPublished - Aug 2004


  • Albumin
  • Artificial liver
  • Bleeding
  • Cirrhosis
  • Dialysis
  • Transplantation

ASJC Scopus subject areas

  • Transplantation
  • Immunology


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