Searching for an Alternate Anticoagulant for Cardiopulmonary Bypass: Does Two Plus Two Equal Two?

Mixing factor Xa and thrombin inhibiting direct oral anticoagulants produces a synergistic prolonging effect on most clotting tests

“…Synergy between rivaroxaban and dabigatran has recently been reported in a study looking for alternatives to heparin anticoagulation in cardiopulmonary bypass. 9 High concentrations of dabigatran (>7500 ng/mL) were necessary to satisfactorily substitute for the usual 3-4 U/mL of heparin in early testing. Reversal of such high levels of dabigatran required large amounts of expensive idarucizumab.…”

“…Reversal of such high levels of dabigatran required large amounts of expensive idarucizumab. 9 Including rivaroxaban at 150-200 ng/mL allowed much reduced levels of dabigatran (2500 ng/ mL) to be used successfully to prevent fibrin formation within the bypass circuit. The quantity of reversing agents required post-surgery was then considered feasible for practical use.…”