Use of the CytoSorb® filter for elimination of residual therapeutic argatroban concentrations during heparinized cardiopulmonary bypass for heart transplantation

Abstract

Introduction: No antidote or established extracorporeal elimination strategy is available for argatroban. Hemadsorption facilitates elimination of smaller drugs. Case Report: A 34-year-old patient underwent urgent heart transplantation. Because of a history of heparin-induced thrombocytopenia, preoperative anticoagulation was performed with argatroban. Despite ceasing of the continuous infusion of argatroban 2 h before surgery, concentration only declined from 0.60 μg/ml to 0.58 μg/ml before surgery, and the activated clotting time (ACT) value shortly was 223 s. Microvascular bleeding had been observed when starting surgery. A CytoSorb® absorption column was integrated into the system of the heparin-anticoagulated cardiopulmonary bypass (CPB) circuit and a flow of 400 mL/min provided during the 2 h of extracorporeal circulation. The argatroban concentration after weaning from CPB was 0.04 μg/ml and satisfying hemostasis had been achieved after protamine administration. Conclusion: Data indicate that the CytoSorb® absorption column might be an effective tool for quick extracorporeal removal of therapeutic concentrations of argatroban.

An In-Depth Analysis of the Multi-Faceted Benefits of Cytosorb Filter Utilization during Cardiopulmonary Bypass

“…However, integrating a CytoSorb absorption column into the cardiopulmonary bypass circuit successfully reduced the argatroban concentration and achieved satisfactory hemostasis. These findings suggest that the CytoSorb filter is an effective method for eliminating therapeutic argatroban concentrations during cardiopulmonary bypass, presenting a potential extracorporeal removal strategy [12].…”

Thrombosis prophylaxis following trauma

“…With predominantly hepatic clearance and a short half-life of approximately 45 min – which may be prolonged in critically ill patients – argatroban is an appealing option for anticoagulation [16]. However, one limitation is the absence of a specific antidote for argatroban, although haemadsorption has been suggested as a potential method for argatroban reversal [36]. Even though bivalirudin, another direct thrombin inhibitor with a short half-life cleared renally/via renal replacement therapy, is used in critically ill patients as well, argatroban has shown superior outcomes in HIT patients [37].…”

Perioperative Considerations in Management of the Severely Bleeding Coagulopathic Patient

“…Such strategies include hemofiltration for agents like bivalirudin or tirofiban or the hemadsorption of ticagrelor, rivaroxaban, edoxaban, and argatroban. [77][78][79][80][81] Nevertheless, in severe trauma, with massive coagulopathy and residual drug effect, such elimination strategies might be considered within a damage control strategy after the patient has been transferred to the intensive care unit (ICU; table 3).…”