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Effective Apixaban removal using hemoadsorption during emergent open-heart surgery: a case report and narrative
Vitor Mendes1, Jaid Mamode2, Jalal Jolou2
1Division of Cardiovascular Surgery, Department of Surgery, Geneva University Hospitals, 1205, Geneva, Switzerland. VitorJose.Nogueira@hcuge.ch.
Background:
The management of hemostasis in patients medicated with apixaban (Eliquis) undergoing emergency cardiac surgery is exceedingly difficult. The body's natural elimination pathways for apixaban prove ineffective in emergency situations, and the impact of hemodialysis is limited. The application of Cytosorb® may attenuate the concentration of apixaban, thereby facilitating the stabilization of these patients.
Case Presentation:
An 84-year-old man treated with apixaban, underwent emergency ascending aorta replacement surgery due to an acute type A aortic dissection. To address the challenges induced by apixaban, we integrated Cytosorb® cartridge into the Cardiopulmonary bypass circuit. There was a 63.7% decrease in perioperative apixaban-specific anti-factor Xa activity. The patient's postoperative course was favourable.
Conclusion:
Hemoadsorption with Cytosorb® may offers a safe and feasible approach for reducing apixaban concentration in emergency cardiac surgery, thereby mitigating the risk of hemorrhagic complications.
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