Charcoal-based hemodiabsorption liver support for episodic type C hepatic encephalopathy

[Guest guest]

Am J Gastroenterol. 2003 Dec;98(12):2763-70.

Charcoal-based hemodiabsorption liver support for episodic type C hepatic

encephalopathy.

Hill K, Hu KQ, Cottrell A, Teichman S, Hillebrand DJ.

Department of Internal Medicine, Loma University Medical Center, Loma

, California, USA

Episodic (acute) type C hepatic encephalopathy (AHE) fails to respond to 5

days of medical therapy in 10-30% of patients and carries a 10-30% mortality

rate. We prospectively studied extracorporeal liver support for AHE failing

to respond to medical therapy to assess its safety and efficacy and the role

of anticoagulation.A series of patients with cirrhosis and AHE failing to

respond to at least 24 h of medical therapy underwent a maximum of three 6-h

charcoal-based hemodiabsorption (Liver Dialysis Unit) treatments. A standard

anticoagulation protocol, with heparin dosing based on activated clotting

time (ACT) determinations, heparin dose-response curve, and target ACT of

275-300 s, was developed. Therapy was terminated if patients met a

predetermined clinical response, deteriorated, or underwent

transplantation.Eighteen patients with grade 2-4 AHE despite 5.9 +/- 3.9

days of medical therapy underwent a mean of 1.6 treatments. In 2.6 +/- 1.9

days, 16 patients (88.9%) improved to less than grade 2 HE or achieved at

least a 50% hepatic encephalopathy index (HEI) reduction. Median mental

status (grade 2 vs 1, p < 0.05) and HEI (0.634 +/- 0.194 vs 0.363 +/- 0.263,

p < 0.005) improved significantly. Survival was 94.4% and 72.2% at 5 and 30

days, respectively. Use of our developed anticoagulation protocol resulted

in less platelet (14.2% +/- 2.8% vs 32.5% +/- 5.8%, p < 0.005) and

fibrinogen consumption (12.1% +/- 3.5% vs 43.3% +/- 8.6%, p < 0.0005) and

blood product use (6.2 +/- 1.8 vs 19.0 +/- 5.6 units, p < 0.05) compared

with treatments according to manufacturer's guidelines.Charcoal-based

hemodiabsorption treatments in which a standardized anticoagulation protocol

is used is safe and effective treatment for AHE not responding to standard

medical therapy.

PMID: 14687830 [PubMed - in process]

[Guest guest]

Am J Gastroenterol. 2003 Dec;98(12):2763-70.

Charcoal-based hemodiabsorption liver support for episodic type C hepatic

encephalopathy.

Hill K, Hu KQ, Cottrell A, Teichman S, Hillebrand DJ.

Department of Internal Medicine, Loma University Medical Center, Loma

, California, USA

Episodic (acute) type C hepatic encephalopathy (AHE) fails to respond to 5

days of medical therapy in 10-30% of patients and carries a 10-30% mortality

rate. We prospectively studied extracorporeal liver support for AHE failing

to respond to medical therapy to assess its safety and efficacy and the role

of anticoagulation.A series of patients with cirrhosis and AHE failing to

respond to at least 24 h of medical therapy underwent a maximum of three 6-h

charcoal-based hemodiabsorption (Liver Dialysis Unit) treatments. A standard

anticoagulation protocol, with heparin dosing based on activated clotting

time (ACT) determinations, heparin dose-response curve, and target ACT of

275-300 s, was developed. Therapy was terminated if patients met a

predetermined clinical response, deteriorated, or underwent

transplantation.Eighteen patients with grade 2-4 AHE despite 5.9 +/- 3.9

days of medical therapy underwent a mean of 1.6 treatments. In 2.6 +/- 1.9

days, 16 patients (88.9%) improved to less than grade 2 HE or achieved at

least a 50% hepatic encephalopathy index (HEI) reduction. Median mental

status (grade 2 vs 1, p < 0.05) and HEI (0.634 +/- 0.194 vs 0.363 +/- 0.263,

p < 0.005) improved significantly. Survival was 94.4% and 72.2% at 5 and 30

days, respectively. Use of our developed anticoagulation protocol resulted

in less platelet (14.2% +/- 2.8% vs 32.5% +/- 5.8%, p < 0.005) and

fibrinogen consumption (12.1% +/- 3.5% vs 43.3% +/- 8.6%, p < 0.0005) and

blood product use (6.2 +/- 1.8 vs 19.0 +/- 5.6 units, p < 0.05) compared

with treatments according to manufacturer's guidelines.Charcoal-based

hemodiabsorption treatments in which a standardized anticoagulation protocol

is used is safe and effective treatment for AHE not responding to standard

medical therapy.

PMID: 14687830 [PubMed - in process]

[Guest guest]

Am J Gastroenterol. 2003 Dec;98(12):2763-70.

Charcoal-based hemodiabsorption liver support for episodic type C hepatic

encephalopathy.

Hill K, Hu KQ, Cottrell A, Teichman S, Hillebrand DJ.

Department of Internal Medicine, Loma University Medical Center, Loma

, California, USA

Episodic (acute) type C hepatic encephalopathy (AHE) fails to respond to 5

days of medical therapy in 10-30% of patients and carries a 10-30% mortality

rate. We prospectively studied extracorporeal liver support for AHE failing

to respond to medical therapy to assess its safety and efficacy and the role

of anticoagulation.A series of patients with cirrhosis and AHE failing to

respond to at least 24 h of medical therapy underwent a maximum of three 6-h

charcoal-based hemodiabsorption (Liver Dialysis Unit) treatments. A standard

anticoagulation protocol, with heparin dosing based on activated clotting

time (ACT) determinations, heparin dose-response curve, and target ACT of

275-300 s, was developed. Therapy was terminated if patients met a

predetermined clinical response, deteriorated, or underwent

transplantation.Eighteen patients with grade 2-4 AHE despite 5.9 +/- 3.9

days of medical therapy underwent a mean of 1.6 treatments. In 2.6 +/- 1.9

days, 16 patients (88.9%) improved to less than grade 2 HE or achieved at

least a 50% hepatic encephalopathy index (HEI) reduction. Median mental

status (grade 2 vs 1, p < 0.05) and HEI (0.634 +/- 0.194 vs 0.363 +/- 0.263,

p < 0.005) improved significantly. Survival was 94.4% and 72.2% at 5 and 30

days, respectively. Use of our developed anticoagulation protocol resulted

in less platelet (14.2% +/- 2.8% vs 32.5% +/- 5.8%, p < 0.005) and

fibrinogen consumption (12.1% +/- 3.5% vs 43.3% +/- 8.6%, p < 0.0005) and

blood product use (6.2 +/- 1.8 vs 19.0 +/- 5.6 units, p < 0.05) compared

with treatments according to manufacturer's guidelines.Charcoal-based

hemodiabsorption treatments in which a standardized anticoagulation protocol

is used is safe and effective treatment for AHE not responding to standard

medical therapy.

PMID: 14687830 [PubMed - in process]

[Guest guest]

Am J Gastroenterol. 2003 Dec;98(12):2763-70.

Charcoal-based hemodiabsorption liver support for episodic type C hepatic

encephalopathy.

Hill K, Hu KQ, Cottrell A, Teichman S, Hillebrand DJ.

Department of Internal Medicine, Loma University Medical Center, Loma

, California, USA

Episodic (acute) type C hepatic encephalopathy (AHE) fails to respond to 5

days of medical therapy in 10-30% of patients and carries a 10-30% mortality

rate. We prospectively studied extracorporeal liver support for AHE failing

to respond to medical therapy to assess its safety and efficacy and the role

of anticoagulation.A series of patients with cirrhosis and AHE failing to

respond to at least 24 h of medical therapy underwent a maximum of three 6-h

charcoal-based hemodiabsorption (Liver Dialysis Unit) treatments. A standard

anticoagulation protocol, with heparin dosing based on activated clotting

time (ACT) determinations, heparin dose-response curve, and target ACT of

275-300 s, was developed. Therapy was terminated if patients met a

predetermined clinical response, deteriorated, or underwent

transplantation.Eighteen patients with grade 2-4 AHE despite 5.9 +/- 3.9

days of medical therapy underwent a mean of 1.6 treatments. In 2.6 +/- 1.9

days, 16 patients (88.9%) improved to less than grade 2 HE or achieved at

least a 50% hepatic encephalopathy index (HEI) reduction. Median mental

status (grade 2 vs 1, p < 0.05) and HEI (0.634 +/- 0.194 vs 0.363 +/- 0.263,

p < 0.005) improved significantly. Survival was 94.4% and 72.2% at 5 and 30

days, respectively. Use of our developed anticoagulation protocol resulted

in less platelet (14.2% +/- 2.8% vs 32.5% +/- 5.8%, p < 0.005) and

fibrinogen consumption (12.1% +/- 3.5% vs 43.3% +/- 8.6%, p < 0.0005) and

blood product use (6.2 +/- 1.8 vs 19.0 +/- 5.6 units, p < 0.05) compared

with treatments according to manufacturer's guidelines.Charcoal-based

hemodiabsorption treatments in which a standardized anticoagulation protocol

is used is safe and effective treatment for AHE not responding to standard

medical therapy.

PMID: 14687830 [PubMed - in process]