Intraoperative ticagrelor removal via hemoadsorption during on-pump coronary artery bypass grafting
Hassan K, Geidel S, Zamvar V, Tanaka K, Knezevic-Woods Z, Wendt D, Deliargyris EN, Storey RF, Schmoeckel M. JTCVS 2023; epub
05/2023
This three centre study prospectively included 11 patients on ticagrelor undergoing urgent coronary artery bypass graft (CABG) surgery. CytoSorb hemoadsorption was incorporated in the cardiopulmonary bypass (CPB) circuit and remained there for the duration of the pump run. Blood samples were collected pre and post CPB so that mean ticagrelor levels could be measured. The time interval between surgery and last ticagrelor dose was £48 hrs and the mean intraoperative hemoadsorption duration was 97 minutes with a mean flow rate through the device of 422 mL/min. Mean ticagrelor levels pre-CPB were 103±63.8 ng/mL compared to mean post CPB levels of 34.0±17.5 ng/mL (significant reduction of 67.1%, p< 0.001). There were no re-operations performed for bleeding and no BARC-4 bleeding events occurred. Median chest tube drainage over 24 hours was 520mL (375mL-930mL). Intraoperative integration of CytoSorb into the CPB circuit was simple and safe without any device related adverse events reported. This is the first in vivo report showing that the intraoperative use of CytoSorb can efficiently remove ticagrelor and significantly reduce circulating drug levels. As the authors state, whether this active removal can reduce serious postoperative bleeding in patients undergoing urgent cardiac surgery is currently being evaluated in the double blinded randomized Safe and Timely Antithrombotic Removal – Ticagrelor (STAR-T) trial.
