38. Ticagrelor Removal With Intraoperative Polymer Bead Hemoadsorption in Patients Undergoing Urgent Coronary Artery Bypass Grafting

Background: Patients on ticagrelor undergoing urgent cardiac surgery are at high risk for perioperative bleeding complications. We measured ticagrelor levels before and after cardiopulmonary bypass (CPB) to determine whether intraoperative hemoadsorption can actively remove ticagrelor in patients undergoing urgent cardiac surgery.
Methods: The hemoadsorption cartridge was incorporated in the CPB circuit and remained active for the duration of the pump run. Blood samples were collected before and after CPB. The main objective of the current analysis was to compare mean total plasma ticagrelor levels (ng/mL) at baseline with ticagrelor levels obtained at the end of CPB. Plasma ticagrelor levels were measured at a certified outside laboratory (Altascience, Laval, QC, Canada). Data are presented as mean ± SD.
Results: A total of 11 patients undergoing urgent CABG at 3 institutions were included (mean age 67.9±9.8 years, 91% male, mean EuroSCORE-II of 3.0±3.3% (range: 0.7-12.4%). Mean intraoperative hemoadsorption duration was 97.1±43.4min with a mean flow rate through the device of 422.9±40.3mL/min. Mean ticagrelor levels pre-CPB were 103.5±63.8ng/mL compared with mean post-CPB levels of 34.0±17.5ng/ml, representing a highly significant 67.1% reduction (P<0.001, Figure). Sites reported that the intraoperative integration of the device was simple and safe without any device-related adverse events reported.
Conclusions: This is the first in vivo report demonstrating that intraoperative hemoadsorption can efficiently remove ticagrelor and significantly reduce circulating drug levels. Whether active ticagrelor removal can reduce serious perioperative bleeding in patients undergoing urgent cardiac surgery is currently evaluated in the double blind, randomized Safe and Timely Antithrombotic Removal – Ticagrelor (STAR-T) trial.

Daniel Wendt (1), Michael Schmoeckel (2), Kambiz Hassan (2), Stephan Geidel (2), Kenichi Tanaka (3), Mark Thomas (4), Jörg Scheier (5), Daniel Wendt (1), Efthymios Deliargyris (6), Robert Storey (7), (1) Westgerman Heart & Vascular Center, Essen, Germany, (2) Asklepios Klinik St. Georg, Hamburg, Germany, (3) Cardiothoracic Division, Baltimore, MD, (4) Institute of Cardiovascular Sciences College of Medical and Dental Sciences, University of Birmi, Birmingham, NA, (5) CytoSorbents Europe GmbH, Müggelseedamm 131, 12587 Berlin, Berlin, NA, (6) CytoSorbents Corporation, Princeton, NJ, (7) University of Sheffield, Sheffield, United Kingdom

Mario Gaudino

Invited Discussant

Dr. Mario Gaudino is the Stephen and Suzanne Weiss Professor in Cardiothoracic Surgery at New York Presbyterian /Weill Cornell Medicine. Dr. Gaudino is an expert in the field of coronary artery bypass surgery and the use of multiple arterial grafts. Along with his expert training and knowledge in coronary artery bypass surgery, Dr. Gaudino also specializes in structural heart disease, valvular dysfunction and complex aortic procedures. In addition to his clinical expertise, Dr. Gaudino is currently the Assistant Dean for Clinical Trials, Director of Translational and Clinical Research in the Department of Cardiothoracic Surgery. He is currently the lead investigator of an international, randomized, controlled trial which aims to determine the optimal strategy for coronary artery bypass surgery (the ROMA trial) and STICH3C, an international, randomized controlled trial that will be the first in comparing the outcomes of PCI and CABG in patients with low ejection fraction. Dr. Gaudino currently serves as the Chair of the Coronary Artery Surgery Task Force of the European Association for Cardio-thoracic Surgery as well as the Chair of the Participant User File (PUF) Review Task Force of the Society of Thoracic Surgeons (Adult Cardiac Subcommittee).  He also serves the Vice-Chair of the AHA Council on Cardiovascular Surgery and Anesthesia CVSA Education and Publications Committee. As a known advocate for scientific integrity and surgical quality, Dr. Gaudino is often called upon to serve on guideline writing committees to help set standards for cardiac surgery both nationally and internationally. 

Michael Schmoeckel

Abstract Presenter

Born 1963 in Stuttgart, Germany 

Medical studies at the Universities of Tuebingen and Munich (LMU) 1982-1988

Training in Cardiac Surgery Dept. of Cardiac Surgery, Klinikum Großhadern, LMU Munich 1990-1996 (Prof. Bruno Reichart)

Research in xenotransplantation, Papworth Hospital (Mr. John Wallwork) 1996-97

Specialist in Cardiac Surgery 2000

Consultant (LMU Munich) 2001

Senior Consultant 2007

Head of Department of Cardiac Surgery, AK St. Georg, Hamburg since 2009

 

Specialties: Adult Cardiac, Mechanical Circulatory Support, Perioperative Management/Critical Care, Treatment/Procedure/Operation/Surgery, Coronary Disease, CABG