engleski

Adsorption of DOAC medications with cytosorb filter in patients undergoing cardiac surgery

Objective: To analyze the use of CytoSorb filter (CytoSorbents gmbh, USA) in patients undergo heartsurgeries used direct oral anticoagulants (DOAC) preoperatively. Patients used different types of DOACs’ are in great risk of perioperative bleeding and withdrawal few days before surgery couldn’t prevent serious bleeding. Case reports and recent studies have shown positive effect of CytoSorb on DOACs purification from circulating blood during extracorporeal circulation (ECC). Methods: Compared patients underwent cardiac surgery receiving preoperative DOACs’ between January 2016 and December 2019. Total number was 35.and divided in G 1 (13 patients - 37%), didn’t treated with CytoSorb, and in G 2, (22 patients - 63 %) treated with filter. Analyzed data were: type of surgery ; amount of blood loss ; resternotomy ; need for blood transfusions, ICU length of stay. Results: Of 13 patients, 6 (46%) in G1, received ticagrelol, 4 (33%) rivaroxaban and 2 dabigatran (17%). In G2, of 22 patients, 13 (59%) received ticagrelol, 8 (36%) rivaroxaban and 1 (5%) dabigatran. Comparing between groups, patients in G1 had longer: total time of surgery (310 vs 240 min) ; amount of drainage in 24 hours (1200 vs. 320 mL) ; red blood cells transfusions (950 vs 250 mL) ; platelets transfusions (800 vs 150 mL) ; transfusions of fresh frozen plasma (1180 vs 620 mL). Resternotomy in G1 was 58.3% versus 18.2% in G2. ICU length of stay was longer in G1 (approx. 5.3 vs. 2.4 days). Conclusions: These results have shown favorable effect of CytoSorb filter in patients with preoperative DOACs’ therapy by adsorbing medication from blood in short time. DOAC’s effect could be prolonged for the several days in oldies, and in patients with renal and liver dysfunction CytoSorb filter decreases DOAC’s0 effect, and the risk of perioperative bleeding, the needs for blood and blood products, length of ICU stay, and overall costs of patients’ management.

DOAC medications ; cytosorb filterts ; cardiac surgery

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