{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T13:09:54Z","timestamp":1758632994250,"version":"3.37.3"},"reference-count":23,"publisher":"The Korean Society of Critical Care Medicine","issue":"4","license":[{"start":{"date-parts":[[2021,11,16]],"date-time":"2021-11-16T00:00:00Z","timestamp":1637020800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"}],"funder":[{"DOI":"10.13039\/100016988","name":"Biomedical Research Institute, Jeonbuk National University Hospital","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100016988","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["accjournal.org"],"crossmark-restriction":true},"short-container-title":["Acute Crit Care"],"published-print":{"date-parts":[[2021,11,30]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.4266\/acc.2021.00276","type":"journal-article","created":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T04:44:25Z","timestamp":1637124265000},"page":"322-331","update-policy":"https:\/\/doi.org\/10.4266\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Bleeding complications associated with the molecular adsorbent recirculating system: a retrospective study"],"prefix":"10.4266","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1742-7487","authenticated-orcid":true,"given":"Seon Woo","family":"Yoo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9959-7908","authenticated-orcid":true,"given":"Min-Jong","family":"Ki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4411-2755","authenticated-orcid":true,"given":"Dal","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2804-2467","authenticated-orcid":true,"given":"Seul Ki","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3774-4375","authenticated-orcid":true,"given":"SeungYong","family":"Park","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1601-0724","authenticated-orcid":true,"given":"Hyo Jin","family":"Han","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8267-8434","authenticated-orcid":true,"given":"Heung Bum","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2790","reference":[{"key":"ref1","first-page":"415","volume-title":"Guidelines for the management of adult acute and acute-on-chronic liver failure in the ICU: cardiovascular, endocrine, hematologic, pulmonary and renal considerations: executive summary","author":"Nanchal","year":"2020"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.3350\/kjhep.2010.16.1.5"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1097\/ccm.0000000000002562"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.4166\/kjg.2009.54.1.28"},{"key":"ref5","first-page":"51","volume-title":"Molecular adsorbent recirculating system as artificial support therapy for liver failure: a meta-analysis","author":"Vaid","year":"2012"},{"key":"ref6","first-page":"118","volume-title":"The Molecular Adsorbent Recirculating System (MARS) in the intensive care unit: a rescue therapy for patients with hepatic failure","author":"Saliba","year":"2006"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1177\/1756284819879565"},{"key":"ref8","first-page":"17046","volume-title":"Meta-analysis of survival with the molecular adsorbent recirculating system for liver failure","author":"He","year":"2015"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1002\/lt.20139"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1002\/hep.29694"},{"key":"ref11","first-page":"280","volume-title":"Equipment review: the molecular adsorbents recirculating system (MARS)","author":"Boyle","year":"2004"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2003.024919"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.biocel.2003.08.002"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1002\/hep.510230630"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840060417"},{"key":"ref16","first-page":"1830","volume-title":"Acute liver failure\/injury related to drug reaction with eosinophilia and systemic symptoms: outcomes and prognostic factors","author":"Ichai","year":"2017"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1007\/s00423-015-1290-2"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2004.09.009"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-019-05783-y"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.4266\/kjccm.2016.00143"},{"key":"ref21","first-page":"115","volume-title":"Hemodynamic changes during isolated liver hemoperfusion of hepatoma","author":"Ha","year":"2004"},{"key":"ref22","first-page":"R24","volume-title":"Molecular adsorbent recirculating system and hemostasis in patients at high risk of bleeding: an observational study","author":"Faybik","year":"2006"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-0012.2004.00172.x"}],"container-title":["Acute and Critical Care"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/accjournal.org\/upload\/pdf\/acc-2021-00276.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/accjournal.org\/journal\/view.php?doi=10.4266\/acc.2021.00276","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/accjournal.org\/upload\/pdf\/acc-2021-00276.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T18:14:40Z","timestamp":1638296080000},"score":1,"resource":{"primary":{"URL":"http:\/\/accjournal.org\/journal\/view.php?doi=10.4266\/acc.2021.00276"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,30]]},"references-count":23,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2021,11]]}},"URL":"https:\/\/doi.org\/10.4266\/acc.2021.00276","relation":{},"ISSN":["2586-6052","2586-6060"],"issn-type":[{"type":"print","value":"2586-6052"},{"type":"electronic","value":"2586-6060"}],"subject":[],"published":{"date-parts":[[2021,11,30]]},"assertion":[{"value":"2021-03-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-08-25","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-11-16","order":2,"name":"published","label":"Published online","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-11-30","order":3,"name":"published","label":"Print publication","group":{"name":"publication_history","label":"Publication History"}}]}}