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Intraoperative haemoadsorption for antithrombotic drug removal during cardiac surgery: initial report of the international safe and timely antithrombotic removal (STAR) registry.
Schmoeckel, Michael; Thielmann, Matthias; Hassan, Kambiz; Geidel, Stephan; Schmitto, Jan; Meyer, Anna L; Vitanova, Keti; Liebold, Andreas; Marczin, Nandor; Bernardi, Martin H; Tandler, Rene; Lindstedt, Sandra; Matejic-Spasic, Marijana; Wendt, Daniel; Deliargyris, Efthymios N; Storey, Robert F.
Affiliation
  • Schmoeckel M; Department of Cardiac Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University, Marchioninistr. 15, Munich, D-81377, Germany. michael.schmoeckel@med.uni-muenchen.de.
  • Thielmann M; Department of Thoracic- and Cardiovascular Surgery, West German Heart and Vascular Center, Essen, Germany.
  • Hassan K; Department of Cardiac Surgery, Asklepios Klinik St. Georg, Hamburg, Germany.
  • Geidel S; Department of Cardiac Surgery, Asklepios Klinik St. Georg, Hamburg, Germany.
  • Schmitto J; Department of Cardiac-, Thoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Hannover, Germany.
  • Meyer AL; Department of Cardiothoracic Surgery, University Hospital Heidelberg, Heidelberg, Germany.
  • Vitanova K; Department of Cardiovascular Surgery, German Heart Centre, Munich, Germany.
  • Liebold A; Department of Cardiothoracic and Vascular Surgery, Ulm University Medical Center, Ulm, Germany.
  • Marczin N; Department of Anaesthesia, Royal Brompton Hospital, Royal Brompton & Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK.
  • Bernardi MH; Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria.
  • Tandler R; Department of Cardiac Surgery, University Hospital Erlangen, Erlangen, Germany.
  • Lindstedt S; Department of Cardiothoracic Surgery and Transplantation, Skåne University Hospital, Lund, Sweden.
  • Matejic-Spasic M; CytoSorbents Europe GmbH, Berlin, Germany.
  • Wendt D; Department of Thoracic- and Cardiovascular Surgery, West German Heart and Vascular Center, Essen, Germany.
  • Deliargyris EN; CytoSorbents Europe GmbH, Berlin, Germany.
  • Storey RF; CytoSorbents Inc, Princeton, NJ, USA.
J Thromb Thrombolysis ; 57(6): 888-897, 2024 Aug.
Article in En | MEDLINE | ID: mdl-38709456
ABSTRACT
Intraoperative antithrombotic drug removal by haemoadsorption is a novel strategy to reduce perioperative bleeding in patients on antithrombotic drugs undergoing cardiac surgery. The international STAR registry reports real-world clinical outcomes associated with this application. All patients underwent cardiac surgery before completing the recommended washout period. The haemoadsorption device was incorporated into the cardiopulmonary bypass (CPB) circuit. Patients on P2Y12 inhibitors comprised group 1, and patients on direct-acting oral anticoagulants (DOAC) group 2. Outcome measurements included bleeding events according to standardised definitions and 24-hour chest-tube-drainage (CTD). 165 patients were included from 8 institutions in Austria, Germany, Sweden, and the UK. Group 1 included 114 patients (62.9 ± 11.6years, 81% male) operated at a mean time of 33.2 h from the last P2Y12 inhibitor dose with a mean CPB duration of 117.1 ± 62.0 min. Group 2 included 51 patients (68.4 ± 9.4years, 53% male), operated at a mean time of 44.6 h after the last DOAC dose, with a CPB duration of 128.6 ± 48.4 min. In Group 1, 15 patients experienced a BARC-4 bleeding event (13%), including 3 reoperations (2.6%). The mean 24-hour CTD was 651 ± 407mL. In Group 2, 8 patients experienced a BARC-4 bleeding event (16%) including 4 reoperations (7.8%). The mean CTD was 675 ± 363mL. This initial report of the ongoing STAR registry shows that the intraoperative use of a haemoadsorption device is simple and safe, and may potentially mitigate the expected high bleeding risk of patients on antithrombotic drugs undergoing cardiac surgery before completion of the recommended washout period.Clinical registration number ClinicalTrials.gov identifier NCT05077124.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Registries / Fibrinolytic Agents / Cardiac Surgical Procedures Limits: Aged / Female / Humans / Male / Middle aged Language: En Journal: J Thromb Thrombolysis Journal subject: ANGIOLOGIA Year: 2024 Document type: Article Affiliation country:

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Registries / Fibrinolytic Agents / Cardiac Surgical Procedures Limits: Aged / Female / Humans / Male / Middle aged Language: En Journal: J Thromb Thrombolysis Journal subject: ANGIOLOGIA Year: 2024 Document type: Article Affiliation country: