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Updated: Jun 28, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Antithrombotic drug removal with hemoadsorption during off-pump coronary artery bypass grafting
Helmut Mair1, Stephanie Ulrich2, Dow Rosenzweig3
1Department of Cardiac Surgery, Artemed Klinikum München Süd Am Isarkanal 30, 81379, Munich, Germany. Helmut.Mair@artemed.de.
Insights
Hemoadsorption effectively reduced bleeding complications in patients undergoing off-pump coronary artery bypass surgery while on antithrombotic drugs. This novel approach demonstrated safety and feasibility, offering a promising solution for managing bleeding risks in high-risk surgical candidates.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Medical Devices
Background:
- Patients undergoing coronary artery bypass grafting (CABG) often use antithrombotic drugs (AT), increasing perioperative bleeding risks.
- Hemoadsorption cartridges integrated into cardiopulmonary bypass circuits are used to mitigate bleeding during CABG.
- This study extends the application of hemoadsorption to patients on AT undergoing off-pump coronary artery bypass (OPCAB).
Purpose of the Study:
- To evaluate the feasibility and safety of using hemoadsorption to reduce bleeding in patients on antithrombotic drugs undergoing OPCAB surgery.
- To assess bleeding outcomes, including Bleeding Academic Research Consortium (BARC)-4 events and 24-hour chest-tube drainage (CTD).
Main Methods:
- Ten patients on various antithrombotic regimens (ticagrelor, rivaroxaban) undergoing OPCAB were treated with hemoadsorption.
- Hemoadsorption cartridges were used with dialysis devices or stand-alone apheresis pumps for a mean treatment time of 145 minutes.
- Bleeding was assessed using BARC-4 criteria, and 24-hour CTD was measured.
Main Results:
- One patient experienced a BARC-4 bleeding event; no surgical re-explorations for bleeding were required.
- Mean 24-hour chest-tube drainage was 680 mL.
- No device-related adverse events were reported during the procedure or a median follow-up of 19.5 months.
Conclusions:
- Hemoadsorption during OPCAB surgery is feasible and safe, particularly when using a stand-alone apheresis pump.
- This innovative approach shows favorable bleeding rates in patients on antithrombotic drugs requiring bypass surgery.
Background:
Patients requiring coronary artery bypass grafting (CABG) are often loaded with antithrombotic drugs (AT) and are at an increased risk for perioperative bleeding complications. Active AT removal by a hemoadsorption cartridge integrated in the cardiopulmonary bypass circuit is increasingly used in this setting to reduce bleeding, and herein we describe the extension of this application in patients on AT undergoing off-pump coronary artery bypass (OPCAB).
Methods:
Ten patients (80% male; mean age: 67.4 ± 9.2years) were treated with ticagrelor (eight patients), rivaroxaban and ticagrelor (one patient), and rivaroxaban (one patient) prior to OPCAB surgery. AT's were discontinued one day before surgery in nine patients and on the day of surgery in one patient, and all patients were also on aspirin. The cohort mean EuroSCORE-II was 2.9 ± 1.5%. A hemoadsorption cartridge was integrated into a dialysis device (n=4) or a stand-alone apheresis pump (n=6) periprocedural, for a treatment time of 145 ± 33 min. Outcome measures included bleeding according to Bleeding Academic Research Consortium (BARC)-4 and 24-hour chest-tube-drainage (CTD).
Results:
Mean operation time was 184 ± 35 min. All patients received a left internal thoracic artery with a mean of 2.3 ± 0.9 total grafts. One patient had a BARC-4 bleeding event and there were no surgical re-explorations for bleeding. Mean 24-hours CTD was 680 ± 307mL. During follow-up of 19.5 ± 17.0 months, none of the patients died or required further reinterventions. No device-related adverse events were reported.
Conclusions:
Hemoadsorption via a stand-alone apheresis pump during OPCAB surgery was feasible and safe. This innovative and new approach showed favorable bleeding rates in patients on antithrombotic drugs requiring bypass surgery.
