Hemadsorption for removal of ticagrelor and direct oral anticoagulants in cardiac surgery

Jackson, Robyn; Trus, Ryan Matthew; El‐Diasty, Mohammad

doi:10.1080/14779072.2022.2044306

Cited by 5 publications

(6 citation statements)

References 58 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Despite an extremely high risk of severe bleeding complications, both patients survived without any consequences. A very recent review by Jackson et al ( 33 ) from Canada specifically evaluated hemoadsorption for removal of ticagrelor and DOACs in cardiac surgery. Authors comprehensively assessed all aspects of CytoSorb therapy, including its demonstrated ability to also remove excessive levels of cytokines and other inflammatory mediators or metabolites.…”

Section: Analysis Of Literature Search Resultsmentioning

confidence: 99%

“…In addition, the authors determined that this treatment may be a cost-saving solution even in urgent cardiac surgery. No publication was identified in the literature search with a budget-impact comparison between the solutions reviewed in our paper, but some prices are reported in the above expert review from Canada ( 33 ). The authors declared that the CytoSorb column costs approximately US$1,500, the DOAC reversal agents idarucizumab and andexanet alfa cost around US$3,482 and US$24,750 per treatment, respectively, while the cost of a single PCC dose is about US$5,670.…”

Section: Analysis Of Literature Search Resultsmentioning

confidence: 99%

“…Moreover, a reported thrombotic event incidence of 10% appears rather high, so the significance of this observation should be further assessed. Noteworthy, these agents are costly (33) and have a short plasma half-life that may lead to a rebound effect once the infusion is ceased (25).…”

Section: Reversal Agents For Doacsmentioning

confidence: 99%

See 2 more Smart Citations

Management of perioperative bleeding risk in patients on antithrombotic medications undergoing cardiac surgery—a systematic review

Matejic-Spasic¹,

Hassan²,

Thielmann³

et al. 2022

J Thorac Dis

View full text Add to dashboard Cite

Background: Antithrombotic drugs increase the risk of bleeding, especially in patients who need urgent surgery without an adequate wash-out period. This review aims to evaluate perioperative bleeding complications in patients on dual antiplatelet therapy (DAPT) or direct-acting oral anticoagulants (DOACs) undergoing high-bleeding risk cardiovascular surgery and to present currently available potential solutions to mitigate antithrombotic therapy-related bleeding complications.Methods: As a first step, we searched for relevant articles, over the last 10 years, in Medline (PubMed) and abstracted clinical information based on pre-defined criteria for bleeding complications. In the next step, an additional search evaluating potential solutions to mitigate bleeding complications was performed. The literature screening and selection process followed the principles derived from the PRISMA statement.Results: From all reviewed studies, a total of 19 articles could be included evaluating the risk for bleeding in cardiac surgery related to DAPT or DOACs and 10 papers evaluating antithrombotic drug reversal or removal in the setting of cardiovascular surgery. Reported bleeding rates ranged between 18% and 41%.The variability of the reported data is remarkable. Idarucizumab is reported to provide optimal perioperative hemostasis in up to 93% of patients. It has been observed that andexanet alfa causes unresponsiveness to the anticoagulant effects of heparin. Antithrombotic removal by intraoperative hemoadsorption is found to be associated with a significant decrease in re-thoracotomy rate, overall procedure duration, administered transfusion volumes, chest-tube drainage, and length of hospitalization.Discussion: Bleeding complications in patients treated with DAPT or DOACs in cardiac surgery are high.New costly reversal agents are available but have not been sufficiently tested in the cardio-surgical setting so far. Interestingly, bleeding-related complications seem to be effectively reduced by applying innovative intraoperative hemoadsorption techniques. Expected results from the ongoing trials should provide better insights concerning the efficacy and safety of several potential solutions. Currently, the variability of reports and the deficit of high-quality studies in this specific setting represent the major limitation for the unbiased conclusion of this review.

show abstract

Section: Analysis Of Literature Search Resultsmentioning

confidence: 99%

Section: Analysis Of Literature Search Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Management of perioperative bleeding risk in patients on antithrombotic medications undergoing cardiac surgery—a systematic review

Matejic-Spasic¹,

Hassan²,

Thielmann³

et al. 2022

J Thorac Dis

View full text Add to dashboard Cite

show abstract

“…Wanted drug removal, however, might also have a place beyond the field of intoxication. In the field of cardiac patients on antiplatelets or oral anticoagulation undergoing emergent cardiac surgery without appropriate washout periods, first promising results are already available, 23 but an in‐depth discussion of this topic is beyond the scope of this article.…”

Section: What Is New and Conclusionmentioning

confidence: 99%

“…"For three of the tested substances (i.e., fluconazole, linezolid and liposomal amphotericin B) drug dosage adaption appears advisable and drug monitoring is generally recommended.Wanted drug removal, however, might also have a place beyond the field of intoxication. In the field of cardiac patients on antiplatelets or oral anticoagulation undergoing emergent cardiac surgery without appropriate washout periods, first promising results are already available,23 but an in-depth discussion of this topic is beyond the scope of this article.Finally, the costs of the therapy also have to be taken into consideration. In countries such as Germany, a negotiable reimbursement supports the use of the device in clinical practise, which is not a given in other countries to our understanding.…”

mentioning

confidence: 99%

Extracorporeal hemoadsorption with the CytoSorb device as a potential therapeutic option in severe intoxications: Review of the rationale and current clinical experiences

Mitrović

Huntjens

Vos

et al. 2022

Clinical Pharmacy Therapeu

View full text Add to dashboard Cite

What is known and objective Many severe intoxications occur with substances with no specific antidote, which is why methods of extracorporeal elimination represent a particularly useful and even critical component in their management. The purpose of this review is to summarize the accumulating evidence and clinical results from the application of CytoSorb hemoadsorption therapy in patients with severe intoxications. Comment The technology represents a promising technique with an increasing number of publications in a variety of severe intoxication scenarios suggesting that early intervention might provide rapid substance removal with subsequent overall clinical improvement. What is new and conclusion Given the tremendous challenges in performing prospective, randomized trials in this field, the strong safety profile of the device and the high acuity of these life‐threatening situations, CytoSorb should be considered as a therapeutic option in severe intoxications, particularly when direct antidotes are not available. However, further clinical data are desirable to provide precise recommendations.

show abstract

Impact of Diabetes in Patients With Acute Myocardial Infarction Undergoing Coronary Artery Bypass Surgery Within 48 Hours

Huenges,

Rainer-Schmidt,

Panholzer

et al. 2024

Heart, Lung and Circulation

View full text Add to dashboard Cite

Hemadsorption for removal of ticagrelor and direct oral anticoagulants in cardiac surgery

Cited by 5 publications

References 58 publications

Management of perioperative bleeding risk in patients on antithrombotic medications undergoing cardiac surgery—a systematic review

Management of perioperative bleeding risk in patients on antithrombotic medications undergoing cardiac surgery—a systematic review

Extracorporeal hemoadsorption with the CytoSorb device as a potential therapeutic option in severe intoxications: Review of the rationale and current clinical experiences

Impact of Diabetes in Patients With Acute Myocardial Infarction Undergoing Coronary Artery Bypass Surgery Within 48 Hours

Contact Info

Product

Resources

About