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Open Access 01-12-2024 | Apixaban | Case Report

Effective Apixaban removal using hemoadsorption during emergent open-heart surgery: a case report and narrative literature review

Authors: Vitor Mendes, Jaid Mamode, Jalal Jolou, Mourad Malki, Christoph Ellenberger, Mustafa Cikirikcioglu, Christoph Huber

Published in: Journal of Cardiothoracic Surgery | Issue 1/2024

Abstract

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.

Paparella D. Cardiopulmonary bypass induced inflammation pathophysiology and treatment. An update Eur J Cardio-Thorac Surg. 2002;21(2):232–44.CrossRef

Naruka V, Salmasi MY, Arjomandi Rad A, Marczin N, Lazopoulos G, Moscarelli M, et al. Use of Cytokine Filters During Cardiopulmonary Bypass: Systematic Review and Meta-Analysis. Heart Lung Circ. 2022;31(11):1493–503.CrossRefPubMed

CytoSorbents Corporation. CytoSorb® Assigned Dedicated Procedure Code in Switzerland. In:PRNewswire. 2018. Available from: https://cytosorbents.com/cytosorb-assigned-dedicated-procedure-code-in-switzerland/. Cited 2023 Oct 9.

CytoSorbents Corporation. Health Canada Authorizes Cytosorb For Use In Hospitalized COVID-19 Patients. In:PRNewswire. 2021. Available from:https://cytosorbents.com/health-canada-authorizes-cytosorb-for-use-in-hospitalized-covid-19-patients/. Cited 2023 Oct 9.

Javanbakht M, Trevor M, Rezaei Hemami M, Rahimi K, Branagan-Harris M, Degener F, et al. Ticagrelor Removal by CytoSorb® in Patients Requiring Emergent or Urgent Cardiac Surgery: A UK-Based Cost-Utility Analysis. Pharmacoecon Open. 2020;4(2):307–19.CrossRefPubMed

Mendes V, Colombier S, Verdy F, Bechtold X, Schlaepfer P, Scala E, et al. Cytosorb ® hemoadsorption of apixaban during emergent cardio-pulmonary bypass: a case report. Perfusion. 2021;36(8):873–5.CrossRefPubMed

Jiménez D, Yusen RD, Ramacciotti E. Apixaban: an Oral Direct Factor-Xa Inhibitor. Adv Ther. 2012;29(3):187–201.CrossRefPubMed

Byon W, Garonzik S, Boyd RA, Frost CE. Apixaban: A Clinical Pharmacokinetic and Pharmacodynamic Review. Clin Pharmacokinet. 2019;58(10):1265–79.CrossRefPubMedPubMedCentral

Poel T, de Rouw N, Péquériaux NCV, van de Kerkhof D, Windsant AMAV, van Marum RJ, et al. Effect of conventional hemodialysis on the apixaban plasma concentration. Hemodialysis International. 2024;28(1):72–6.CrossRefPubMed

10.

Connolly SJ, Crowther M, Eikelboom JW, Gibson CM, Curnutte JT, Lawrence JH, et al. Full Study Report of Andexanet Alfa for Bleeding Associated with Factor Xa Inhibitors. New England Journal of Medicine. 2019;380(14):1326–35.CrossRefPubMed

11.

Beik N, Reddy P, Sylvester KW, Connell NT, Giugliano RP, Piazza G, et al. Andexanet Alfa (Andexxa) Formulary Review. Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine. 2019;18(2):66–71.CrossRef

12.

Wei S, Zhang Y, Zhai K, Li J, Li M, Yang J, et al. CytoSorb in patients with coronavirus disease 2019: A rapid evidence review and meta-analysis. Front Immunol. 2023;31:14.

13.

Abraham P, Mendes V, Kirsch M, Schneider A. Hemoperfusion in Cardiac Surgery and ECMO. In: Ronco C, Bellomo R, editors. Contributions to Nephrology Adsorption: The New Frontier in Extracorporeal Blood Purification. S.Karger AG; 2023;180–91. Available from: https://karger.com/doi/10.1159/000527338

14.

Røed-Undlien H, Schultz NH, Lunnan A, Husebråten IM, Wollmann BM, Molden E, et al. In Vitro Apixaban Removal By CytoSorb Whole Blood Adsorber: An Experimental Study. J Cardiothorac Vasc Anesth. 2022;36(6):1636–44.CrossRefPubMed

15.

Buonocore M, Rex S, Degezelle K, Meyns B. CytoSorb haemoadsorption for removal of apixaban—A proof-of-concept pilot case for a randomized controlled trial. J Clin Pharm Ther. 2022;47(12):2373–5.CrossRefPubMed

16.

Hassan K, Thielmann M, Easo J, Kamler M, Wendt D, Haidari Z, et al. Removal of Apixaban during Emergency Cardiac Surgery Using Hemoadsorption with a Porous Polymer Bead Sorbent. J Clin Med. 2022;11(19):5889.CrossRefPubMedPubMedCentral

17.

Dalmastri V, Angelini A, Minerva V, Ballarini M, Grammatico F, Todeschini P, et al. Extracorporeal hemoadsorption therapy as a potential therapeutic option for rapid removal of Apixaban in high risk-surgical patients: a case report. J Med Case Rep. 2023;17(1):283.CrossRefPubMedPubMedCentral

18.

Dhokia V, Madhavan D, Austin A, Morris CG. Novel use of Cytosorb^TM haemadsorption to provide biochemical control in liver impairment. J Intensive Care Soc. 2019;20(2):174–81.CrossRefPubMed

Title: Effective Apixaban removal using hemoadsorption during emergent open-heart surgery: a case report and narrative literature review
Authors: Vitor Mendes
Jaid Mamode
Jalal Jolou
Mourad Malki
Christoph Ellenberger
Mustafa Cikirikcioglu
Christoph Huber
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Apixaban
Heart Surgery
Heart Surgery
Published in: Journal of Cardiothoracic Surgery / Issue 1/2024
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/s13019-024-02748-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effective Apixaban removal using hemoadsorption during emergent open-heart surgery: a case report and narrative literature review

Abstract

Background

Case presentation

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Case presentation

Conclusion

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Correction: Successful treatment of cardiogenic shock due to Takotsubo syndrome with implantation of a temporary microaxial left ventricular assist device in transaxillary approach