The application of low molecular heparin in the treatment of liver failure patients with non-biological artificial liver system

Abstract

Abstract: Objective To observe the anticoagulation effect and safety of low molecular heparin (LMWH) in liver failure patients treated with artificial liver system.Methods A total of 161 liver failure patients treated with dual plasma molecular adsorption system (DPMAS) combined with plasma exchange (PE) from June 2021 to June 2022 were selected. They were divided into a well-anticoagulated group, an under-anticoagulated group, and an over-anticoagulated group based on the anticoagulant effect of LMWH during treatment. The proportion of patients with good anticoagulation in different LMWH dose groups and the baseline levels of patients in the three groups were compared. Results Of the 81 patients, 65 were male, with a mean age of 54.55 years and 41 were hepatitis B virus (HBV) infected. A total of 161 DPMAS combined with PE treatments were performed and all were successfully completed. Among them, 131 were in the good anticoagulation group, 9 in the insufficient anticoagulation group and 21 in the over-anticoagulation group. There were no significant differences in gender, age, baseline level of total bilirubin (TBil) and albumin (Alb) among the three groups (P values were 0.712, 0.658, 0.079 and 0.057, respectively). When prothrombin avtivity (PTA)>30% and platelet (PLT) > 40×10⁹/L, the proportion of LMWH with good anticoagulative effect was > 83%; hemoblobin (HB) and PLT levels were significantly higher in patients in the under-anticoagulated group than in the well-anticoagulated group (all P values were 0.000); compared with the well-anticoagulated group, patients in the over-anticoagulated group had significantly lower PTA and HB and higher international normalized ratio (INR) values (P values were 0.000, 0.000 and 0.027). Within 24 hours prior the end of treatment, 18 patients experienced blood leakage from the central venous line and 3 experienced gingival bleeding, but no other serious complications such as gastrointestinal bleeding occurred. Conclusion When patients with early liver failure and good PLT levels are treated with DPMAS+PE, different doses of LMWH should be given according to the pre-treatment PTA and PLT levels, and the effect of HB on anticoagulation should also be considered.

Key words: Liver failure, Artificial liver, Low molecular heparin, Coagulation

TANG Ru-jia, HU Yan-ming, YAO Hong-yu, XING Han-qian, ZHOU Xia, WANG Kai-li, LIU Hong-ling, ZHAO Jun. The application of low molecular heparin in the treatment of liver failure patients with non-biological artificial liver system[J]. Chinese Hepatolgy, 2023, 28(9): 1024-1027.

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