Ticagrelor and Rivaroxaban Elimination With CytoSorb Adsorber Before Urgent Off-Pump Coronary Bypass

Area of Science:

• Cardiovascular Surgery
• Critical Care Medicine
• Pharmacology

Background:

• Managing patients on dual antiplatelet therapy (ticagrelor) and anticoagulation (rivaroxaban) for coronary artery disease and atrial fibrillation presents challenges for urgent cardiac surgery.
• Urgent off-pump coronary artery bypass (OPCAB) surgery in patients with high bleeding risk requires careful management of prothrombotic and anticoagulant medications.
• Percutaneous coronary intervention (PCI) can lead to complications like arterial dissection, necessitating urgent surgical intervention.

Observation:

• A 58-year-old male patient required urgent OPCAB due to left anterior descending artery dissection during PCI.
• The patient was on ticagrelor for coronary artery disease and rivaroxaban for atrial fibrillation, posing a high bleeding risk.
• CytoSorb hemoadsorption was employed preoperatively to mitigate the effects of these medications.

Findings:

• Intraoperative and postoperative bleeding was adequately controlled.
• The patient's surgical and recovery courses were uneventful following CytoSorb hemoadsorption.
• CytoSorb hemoadsorption demonstrated efficacy in removing coagulative active medications.

Implications:

• CytoSorb hemoadsorption offers a potential strategy for managing patients on ticagrelor and rivaroxaban requiring urgent cardiac surgery.
• This hemoadsorption technique may facilitate safer surgical procedures in high-risk bleeding patients.
• Further investigation into hemoadsorption for managing anticoagulant and antiplatelet agents in surgical settings is warranted.