CytoSorbents Corporation (CTSO)

[techxen]

Open Heart journal - Norway experience with DOACS

Published this month in the Open Heart journal:

Operative survival in patients with acute aortic disease in the era of newer oral anticoagulants
https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwijveer59HqAhWHT98KHdzUCG0QFjAIegQICRAB&url=https%3A%2F%2Fopenheart.bmj.com%2Fcontent%2Fopenhrt%2F7%2F2%2Fe001278.full.pdf&usg=AOvVaw0bTds2Gevc1nWiW-nFtPYv

Open Heart journal contains peer reviewed medical research in all disciplines and therapeutic areas of cardiovascular medicine and is the official journal of the British Cardiovascular Society.

This paper outlined a study by cardiothoracic surgeons at Oslo University Hospital in Norway. The study analyzed the risk associated with direct oral anticoagulants (DOACs) in patients undergoing non-elective operations on the proximal aorta due to aortic disease, with an emphasis on operative mortality.

One of the things that stood out to me was the extraordinarily high mortality rate - of 135 non-elective operations between 2016 and to 2018, 19 patients died during the first 90 days. DOAC use was the top-ranked risk factor. In the DOAC group they studied, 30-day mortality rate was 67% versus 9% in patients not using DOAC. All deaths among the DOAC-treated patients were bleeding related, while this was not the case in any of the other groups. Most of the patients using DOAC were also older.

In Norway, DOACs have gained popularity and, of anticoagulant users in 2018, 27% used warfarin and 73% used DOAC. The DOACs are now the most used anticoagulants in Norway. So they are projecting the number of DOAC users requiring acute cardiac surgery to also likely to increase.

Another noteworthy point they made was that only 8% use dabigatran (Pradax), and the surgeons do not yet have experience yet with the dabigatran reversal agent Praxbind. Apixaban (Eliquis) is the most used anticoagulant in Norway and they confirmed that there are concerns over using Andexxa (the only approved reversal agent).

The highlight of the article however was toward the end where they reference the study in Germany and indicate they are watching what is going on with Cytosorb: "In patients using rivaroxaban or ticagrelor, the same group has also described promising effects of CytoSorb®, a whole blood adsorber for extracorporeal purification of blood that may be used with a heart-lung machine during cardiac surgery".

Remember it was only this year that the company received EU approval for the removal of ticagrelor and Rivaroxaban (Xarelto), but as this article demostrates, word is getting out now across the countries in Europe. Because Norway is now a direct sales country (taken back from Fresenius), hopefully this will aid in more rapid adoption.