Use of the CytoSorb® filter for elimination of residual therapeutic argatroban concentrations during heparinized cardiopulmonary bypass for heart transplantation
Andreas Koster et al. Perfusion. 2022.
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Perfusion
. 2022 May 26;2676591221093875.
doi: 10.1177/02676591221093875. Online ahead of print.
Authors
Andreas Koster 1 , Helmuth Warkentin 1 , Vera von Dossow 1 , Michiel Morshuis 2
Affiliations
1 Institute of Anesthesiology and Pain Therapy, Bad Oeynhausen, Germany.
2 Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Ruhr-University Bochum, Germany.
PMID: 35619539
DOI: 10.1177/02676591221093875
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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.
Keywords: Anticoagulation reversal; bleeding; coagulopathy.
