CytoSorb hemoadsorption of apixaban during cardio-pulmonary bypass for heart transplantation
Background: Heart transplantation is an emergency surgery requiring cardio-pulmonary bypass (CPB) and its timing is unpredictable. Patients on the transplant waiting list often have multiple reasons for being anticoagulated. Intraoperative removal of apixaban using CytoSorb seems to be an interestin...
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Elsevier
2025-02-01
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| Series: | JHLT Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950133424001149 |
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| author | Anouk Frering, MD Antoine Abi Lutfallah, MD Aude Carillion, MD, PhD Daniel Wendt, MD Pascal Leprince, MD, PhD Adrien Bougle, MD, PhD Guillaume Lebreton, MD, PhD |
| author_facet | Anouk Frering, MD Antoine Abi Lutfallah, MD Aude Carillion, MD, PhD Daniel Wendt, MD Pascal Leprince, MD, PhD Adrien Bougle, MD, PhD Guillaume Lebreton, MD, PhD |
| author_sort | Anouk Frering, MD |
| collection | DOAJ |
| description | Background: Heart transplantation is an emergency surgery requiring cardio-pulmonary bypass (CPB) and its timing is unpredictable. Patients on the transplant waiting list often have multiple reasons for being anticoagulated. Intraoperative removal of apixaban using CytoSorb seems to be an interesting solution for patients on DOACs requiring an emergency CPB intervention. The aim of this short communication is to describe the perioperative effects of the use of the CytoSorb hemoadsorption device during emergency CPB for a heart transplant patient. Methods: A 61-year-old male patient wait-listed for heart transplantation was admitted to our hospital to benefit from a heart transplantation. This patient, has an end-stage heart failure with multiple episodes of decompensation over the previous year. He was anticoagulated with a Vitamin K antagonist (VKA) due to atrial fibrillation and was switched to apixaban. Hemoadsorption by a CytoSorb cartridge was performed during the entire CPB duration. Anti-Factor Xa Activity (AFXaA) levels were taken before, during and after surgery in order to monitor anticoagulation. Results: Surgery consisted of an orthotopic heart transplantation with bi-caval anastomoses. At the time of anesthesia induction and after UFH administration, AFXaA levels were 330ng/mL and 317ng/mL, respectively. Thereafter, AFXaA decreased to 137ng/mL during CPB and to 57ng/mL after the end of CPB and protamine administration. After surgery, AFXaA levels stabilized over 50ng/mL over the next 14 hours. No primary graft dysfunction was observed, and during the post-operative period of 72 hours, the patient did not have any bleeding events requiring reintervention or transfusion. Conclusion: We observed that CytoSorb could be a potential solution to remove apixaban intraoperatively. If this efficacy is confirmed in larger trials, it would allow transplant candidates to be treated with DOACs without requiring a switch to VKAs. |
| format | Article |
| id | doaj-art-30fde6c2687448e497d20965e4386128 |
| institution | Kabale University |
| issn | 2950-1334 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JHLT Open |
| spelling | doaj-art-30fde6c2687448e497d20965e43861282025-02-09T05:01:53ZengElsevierJHLT Open2950-13342025-02-017100165CytoSorb hemoadsorption of apixaban during cardio-pulmonary bypass for heart transplantationAnouk Frering, MD0Antoine Abi Lutfallah, MD1Aude Carillion, MD, PhD2Daniel Wendt, MD3Pascal Leprince, MD, PhD4Adrien Bougle, MD, PhD5Guillaume Lebreton, MD, PhD6Sorbonne University, Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Corresponding author: Anouk Frering, Sorbonne University, Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 47-83, Boulevard de l′Hôpital, Paris, 75013, France.Sorbonne University, Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, FranceSorbonne University, Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, FranceCytoSorbents Europe GmbH, Berlin, Germany; Department of Thoracic- and Cardiovascular Surgery, Westgerman Heart and Vascular Center, University Duisburg-Essen, Essen, GermanySorbonne University, Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, FranceSorbonne University, Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, FranceSorbonne University, Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, FranceBackground: Heart transplantation is an emergency surgery requiring cardio-pulmonary bypass (CPB) and its timing is unpredictable. Patients on the transplant waiting list often have multiple reasons for being anticoagulated. Intraoperative removal of apixaban using CytoSorb seems to be an interesting solution for patients on DOACs requiring an emergency CPB intervention. The aim of this short communication is to describe the perioperative effects of the use of the CytoSorb hemoadsorption device during emergency CPB for a heart transplant patient. Methods: A 61-year-old male patient wait-listed for heart transplantation was admitted to our hospital to benefit from a heart transplantation. This patient, has an end-stage heart failure with multiple episodes of decompensation over the previous year. He was anticoagulated with a Vitamin K antagonist (VKA) due to atrial fibrillation and was switched to apixaban. Hemoadsorption by a CytoSorb cartridge was performed during the entire CPB duration. Anti-Factor Xa Activity (AFXaA) levels were taken before, during and after surgery in order to monitor anticoagulation. Results: Surgery consisted of an orthotopic heart transplantation with bi-caval anastomoses. At the time of anesthesia induction and after UFH administration, AFXaA levels were 330ng/mL and 317ng/mL, respectively. Thereafter, AFXaA decreased to 137ng/mL during CPB and to 57ng/mL after the end of CPB and protamine administration. After surgery, AFXaA levels stabilized over 50ng/mL over the next 14 hours. No primary graft dysfunction was observed, and during the post-operative period of 72 hours, the patient did not have any bleeding events requiring reintervention or transfusion. Conclusion: We observed that CytoSorb could be a potential solution to remove apixaban intraoperatively. If this efficacy is confirmed in larger trials, it would allow transplant candidates to be treated with DOACs without requiring a switch to VKAs.http://www.sciencedirect.com/science/article/pii/S2950133424001149heart transplantationCytoSorbdirect oral anticoagulantshemoadsorptionapixabancardio-pulmonary bypass |
| spellingShingle | Anouk Frering, MD Antoine Abi Lutfallah, MD Aude Carillion, MD, PhD Daniel Wendt, MD Pascal Leprince, MD, PhD Adrien Bougle, MD, PhD Guillaume Lebreton, MD, PhD CytoSorb hemoadsorption of apixaban during cardio-pulmonary bypass for heart transplantation JHLT Open heart transplantation CytoSorb direct oral anticoagulants hemoadsorption apixaban cardio-pulmonary bypass |
| title | CytoSorb hemoadsorption of apixaban during cardio-pulmonary bypass for heart transplantation |
| title_full | CytoSorb hemoadsorption of apixaban during cardio-pulmonary bypass for heart transplantation |
| title_fullStr | CytoSorb hemoadsorption of apixaban during cardio-pulmonary bypass for heart transplantation |
| title_full_unstemmed | CytoSorb hemoadsorption of apixaban during cardio-pulmonary bypass for heart transplantation |
| title_short | CytoSorb hemoadsorption of apixaban during cardio-pulmonary bypass for heart transplantation |
| title_sort | cytosorb hemoadsorption of apixaban during cardio pulmonary bypass for heart transplantation |
| topic | heart transplantation CytoSorb direct oral anticoagulants hemoadsorption apixaban cardio-pulmonary bypass |
| url | http://www.sciencedirect.com/science/article/pii/S2950133424001149 |
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