Cytosorb adsorption during emergency cardiac operations in patients at high risk of bleeding

Abstract Background To analyze the results of Cytosorb adsorption (CytoSorbents Inc., USA) during emergency open-heart operations in patients at high risk of bleeding due to treatment with coagulation-active substances. Methods We investigated 55 consecutive patients (median age 70 [IQR 60,77] years) who underwent emergency cardiac surgery at our institution between June 2016 and June 2018. All patients were on therapy with either Ticagrelor (n=43) or Rivaroxaban (n=12). In 39 of 55 cases, we routinely installed standardized Cytosorb adsorption into the heart-lung-machine (CA-group). Bleeding complications during and after surgery were analyzed in detail and compared to 16 patients without adsorption (WA-group). Results In CA-group no re-thoracotomies had to be performed. Drainage volumes over 24-hours were only 350 [IQR 300,450] ml after Ticagrelor administration and 390 [IQR 310,430] ml after Rivaroxaban therapy. In the majority of patients, transfusions of blood products were not needed. Compared to this, among the WA-group patients, multiple bleeding complications occurred. These were associated with longer total operation (p=0.0042) , higher drainage volumes (p=0.0037), more transfusions of red blood cells (p=0.0119) and transfusion of platelet (p=0.0475), a significantly higher re-thoracotomy rate (p=0.0003), significantly prolonged retention in the intensive care unit (p=0.0141) and a longer hospital stay (p=0.0244). Conclusions The intra-operative use of Cytosorb adsorption of Ticagrelor and Rivaroxaban in emergency open-heart operations is reported for the first time. The data show that the strategy is safe and an effective method to reduce bleeding complications. We recommend the use for safety in patients with Ticagrelor or Rivaroxaban undergoing emergency cardiac surgery.