CytoSorb usage in a dual antiplatelet agent treated patient during CABG and broken guidewire retrieval from right coronary artery ostium
Kumar N, Keshri K, Rhuyan RR. IJMDAT 2022; 5: e379
04/06/2022
New!Peer Reviewed Published DataSafetyTransfusionsAnti throm. removalCardiac surgeryCase reportCPBCritical CareIntra-Op
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Summary
In this case report a 66-year-old male patient on doublet antiplatelet therapy (DAPT) with ticagrelor and ecospirin underwent percutaneous transluminal coronary angioplasty (PTCA) for triple vessel disease (TVD). During withdrawal part of the guidewire became stuck in the right coronary artery. The patient began to deteriorate clinically (left ventricular ejection fraction reduced to 40% with akinetic walls and early pulmonary edema) so he was taken for emergency on-pump coronary artery bypass graft (CABG) surgery, despite being on DAPT. CytoSorb was added to the cardiopulmonary bypass circuit in an effort to remove the ticagrelor and reduce the risk of bleeding. Post-operatively no bleeding was recorded. The patient demonstrated good pump function and sinus rhythm and was able to be discharged in a stable condition within 7 days of hospitalization including 3 days of intensive care unit stay. According to the authors use of intraoperative CytoSorb – in line with earlier reports – prevented expected substantial postoperative bleeding, which led to short ICU stay and total hospitalization time. The authors conclude that intra-operative use of CytoSorb during emergency cardiac surgery in patients treated with ticagrelor is an effective option which reduces risk of bleeding complications, thereby improving outcomes, reducing costs and minimizing morbidity and mortality.
