Ticagrelor Elimination Prior To Urgent OPCAB
Helmut Mair1, Frank Vogel2, Peter Lamm1.
1Cardiac Surgery, Chirurgisches Klinikum München Süd, Munich, Germany, 2Department of Anesthesia, Chirurgisches Klinikum München Süd, Munich, Germany.
Background: In the aera of new and more pharmacodynamically potent antiplatelet drugs and novel direct oral anticoagulants increasingly aggressive prevention strategies were applied for the traetment of coronary arterial disease to lower adverse events. In the setting of emergency or urgent cardiac surgery, however, their use is associated with higher risk of bleeding and adverse events. We therefore used Cytosorb adsorption direct before urgent off pump coronary arterial bypass (OPCAB) operations in patients at high risk of bleeding due to treatment with these coagulation-active substances, ticacrelor and rivaroxaban. Methods: Four patients (63±10 yrs) with three on ticacrelor, one on rivaroxaban and one on ticagrelor and rivaroxaban were admitted for urgent bypass operation in OPCAB-technique. They were treated in addition with acetylsalicylic acid. A Cytosorb adsorber inserted in a conventional dialysis device was started preoperatively to eliminate these coagulative active medications. Adsorbtion time was 2,9±0,2 hrs.Results: The patients received 1,8±0,8 bypass grafts. 24h-drainage from chest tubes was 608±555 ml. Hb dropped from 12,8±1,6 g/dl preoperatively to a minimum of 8,9±1,0 g/dl postoperatively. Two Patients needed 2 and 1 units of red blood cells. Intra- and postoperative OPCAB-course was uneventful in all cases with satisfactory control of intra- and postoperative bleeding. Patients were discharched as planned. Six-months follow up was uneventful. Conclusions: CytoSorb hemoabsorption prior to urgent OPCAB operations appears to be safe and effective for bleeding control in patients on ticagrelor and rivaroxaban.
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