Removal of dabigatran using sorbent hemadsorption

Area of Science:

• Cardiovascular medicine
• Pharmacology
• Biomedical engineering

Background:

• The Redual PCI trial confirmed the safety of combining dabigatran with ticagrelor or clopidogrel for stroke prevention in atrial fibrillation patients.
• While idarucizumab effectively reverses dabigatran, a method to counteract both dabigatran and ticagrelor is lacking.
• A previously successful hemadsorption technique for ticagrelor removal was investigated for dabigatran removal.

Purpose of the Study:

• To evaluate the efficacy of a sorbent hemadsorption method in removing dabigatran from human blood.
• To assess the impact of dabigatran removal on activated partial thromboplastin time (aPTT) values.

Main Methods:

• Dabigatran-spiked bovine serum albumin (BSA) solution was passed through varying volumes (10, 20, 40 mL) of sorbent columns.
• Dabigatran concentrations were quantified using liquid chromatography-tandem mass spectrometry (LC-MS/MS).
• In a human volunteer study, plasma aPTT was measured pre- and post-dabigatran administration and after hemadsorption treatment.

Main Results:

• Sorbent hemadsorption significantly reduced dabigatran concentration from over 1456 nM to undetectable levels with a 40 mL column.
• The hemadsorption process restored aPTT values to below baseline levels in the human volunteer study.
• A 10 mL CytoSorb column reduced dabigatran levels to 67 ± 59 nM (P = 0.002), and a 40 mL column to undetectable levels.

Conclusions:

• Sorbent hemadsorption effectively removes dabigatran, similar to its proven efficacy with ticagrelor.
• The method successfully reverses the anticoagulant effect of dabigatran, normalizing aPTT levels.
• This hemadsorption technique offers a potential clinical strategy for managing dabigatran-related anticoagulation.