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Cytosorb Adsorption During Emergency Cardiac Operations in Patients at High Risk of Bleeding

Kambiz Hassan1, Jochen Kannmacher2, Peter Wohlmuth3

  • 1Department of Cardiac Surgery, Asklepios Klinik St. Georg, Hamburg, Germany.

The Annals of Thoracic Surgery
|January 27, 2019
PubMed

Insights

Cytosorb adsorption effectively reduced bleeding complications in high-risk cardiac surgery patients on ticagrelor or rivaroxaban. This safe strategy minimized reoperations and transfusions, improving patient outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Anesthesiology
  • Hematology

Background:

  • Patients undergoing emergency open heart surgery often receive coagulation-active substances like ticagrelor or rivaroxaban, increasing bleeding risk.
  • Managing bleeding complications in these high-risk patients is a critical challenge in cardiac surgery.

Purpose of the Study:

  • To analyze the efficacy and safety of Cytosorb (CytoSorbents) adsorption in reducing bleeding during emergency open heart operations.
  • To evaluate the impact of Cytosorb adsorption on patients treated with ticagrelor or rivaroxaban.

Main Methods:

  • A study of 55 consecutive patients undergoing emergency cardiac surgery between June 2016 and June 2018.
  • Cytosorb adsorption was implemented in the heart-lung machine for 39 patients, while 16 served as a control group without adsorption.
  • Bleeding complications, transfusion requirements, and post-operative outcomes were compared between the two groups.

Main Results:

  • Patients with Cytosorb adsorption experienced no rethoracotomies and significantly lower 24-hour drainage volumes (350-390 mL) compared to the non-adsorption group.
  • The majority of patients in the Cytosorb group did not require blood product transfusions.
  • The non-adsorption group showed significantly higher rates of bleeding complications, rethoracotomies, longer operation times, increased drainage, more transfusions, and prolonged ICU and hospital stays.

Conclusions:

  • Intraoperative Cytosorb adsorption is a safe and effective method for managing bleeding in patients on ticagrelor or rivaroxaban undergoing emergency cardiac surgery.
  • The study recommends Cytosorb adsorption to enhance safety and reduce complications in this patient population.
  • This represents the first report on the intraoperative use of Cytosorb adsorption for these specific anticoagulant therapies in emergency cardiac operations.
Abstract

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