[Exploring the efficacy and safety profile of the use of a heparin-free integrated tandem pre-flushing method for DPMAS treatment in patients with liver failure].

Abstract

Objective: To compare the efficacy and safety profiles of heparin and heparin-free pre-flushing methods in patients with liver failure treated with a double plasma molecular adsorption system (DPMAS). Method: A prospective, single-center observational study was conducted. Patients with liver failure who received DPMAS treatment at the Liver Disease Center of Nanfang Hospital, Southern Medical University, between October 2024 and February 2025 were consecutively screened for inclusion. The choice of whether to use the heparin pre-flushing method was determined in accordance with the clinicians' clinical experience. Demographic characteristics, treatment-related variables (heparin pre-flush method, adverse events, and pressure parameters), and clinical indicators (liver biochemical parameters, coagulation parameters, and inflammatory markers) were collected before and 48 hours after treatment. Categorical variables were compared using the χ² test. Inter-group comparisons of continuous variables were performed using t-tests or non-parametric tests. Result: Data from 128 patients with liver failure treated with DPMAS were included. The mean age was 44.5 years, with 115 males (89.8%) and 13 females (10.2%). The internal jugular vein was the primary vascular access in both groups. Baseline data showed that coagulation parameters were worse in the heparin-free group than in the heparin group (P<0.05). After DPMAS treatment, changes were observed in both pre-flushing groups, including total bilirubin (heparin group pre-and post-treatment mean: 381.62 μmol/L vs. 337.36 μmol/L, P<0.001; heparin-free group pre-and post-treatment mean: 404 μmol/L vs. 379 μmol/L, P=0.022), albumin (heparin group pre-and post-treatment mean: 33.48 g/L vs. 33.49 g/L, P=0.056; heparin-free group pre- and post-treatment mean: 31.41 g/L vs. 32.42 g/L, P=0.052), prothrombin activity (heparin group pre-and post-treatment median: 41.5% vs. 42.0%, P=0.103; heparin-free group pre-and post-treatment median: 33.90% vs. 32.35%, P=0.022), C-reactive protein (heparin group pre-and post-treatment median: 13.17 mg/L vs. 13.32 mg/L, P=0.004; heparin-free group pre-and post-treatment median: 16.29 mg/L vs. 19.30 mg/L, P=0.415), and procalcitonin (heparin group pre-and post-treatment median: 0.783 ng/mL vs. 0.796 ng/mL, P=0.598; heparin-free group pre-and post-treatment median: 0.82 ng/mL vs. 1.15 ng/mL, P=0.172). Regarding treatment efficacy, there were no statistically significant differences in the magnitude of changes in total bilirubin and albumin before and after treatment between the two pre-flushing methods (P=0.144, P=0.843). In terms of safety profile, there were no statistically significant differences in the magnitude of changes in prothrombin time, international normalized ratio, and prothrombin activity before and after treatment with the two pre-flushing methods (P=0.395, P=0.474, P=0.965). Regarding adverse events, there were no statistically significant differences in abnormal treatment parameters, bleeding, circuit clotting, and hypotension during treatment between the two groups (P>0.05). Conclusion: The heparin-free pre-flushing method can be safely and effectively applied during DPMAS treatment in patients with liver failure with relatively poor coagulation function and an increased risk of bleeding. The heparin-free pre-flush method may be more preferable from patient and nursing perspectives.