CytoSorb haemoadsorption for removal of apixaban—A proof‐of‐concept pilot case for a randomized controlled trial. (9th November 2022)

• Record Type: Journal Article
• Authors: Buonocore, Marianna; Rex, Steffen; Degezelle, Karlien; Meyns, Bart
• Is Part Of: Journal of clinical pharmacy and therapeutics. Volume 47:Number 12(2022)
• Page Start: 2373
• Page End: 2375
• Publication Date: 2022-11-09
• Subjects: apixaban -- CytoSorb -- haemoadsorption; Clinical pharmacology -- Periodicals; Chemotherapy -- Periodicals; 615
• DOI: 10.1111/jcpt.13802
• Languages: English
• ISSNs: 0269-4727

Abstract

Abstract: What is known and objective: Emergent cardiac surgery in patients under anticoagulant therapy is still a major point of concern. Recently approved reversal agents are often not available or not suitable in the cardiac surgery setting, and timely discontinuation of the drug is not always feasible. CytoSorb® haemoadsorption therapy has been approved in Europe for intraoperative ticagrelor and rivaroxaban removal during cardiopulmonary bypass (CPB), but thus far the efficacy of CytoSorb® haemoadsorber on other anticoagulants (apixaban, dabigatran, edoxaban) has only been tested in vitro, and some signals of clinical benefits have reported in a few case reports. Case summary: We describe a case of CPB implementation with CytoSorb® in a haemodynamic unstable patient with prosthetic aortic valve endocarditis on apixaban therapy. What is new and conclusion: CytoSorb® proved to be effective for removal of apixaban in emergency surgery setting by direct measurements of drug levels before and during CPB circulation. Abstract : Timely discontinuation of NOAC's therapy before surgery is not always achievable, especially in an emergency setting. This case report proves, with direct blood concentration measurements, the efficacy of CytoSorb hemofilter in apixaban removal during cardiopulmonary bypass for emergency aortic valve replacement.