Hassan Kambiz, Geidel Stephan, Zamvar Vipin, Tanaka Kenichi, Knezevic-Woods Zelka, Wendt Daniel, Deliargyris Efthymios N, Storey Robert F, Schmoeckel Michael
Department of Cardiac Surgery, Asklepios Klinik St Georg, Hamburg, Germany.
Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom.
JTCVS Open. 2023 May 6;15:190-196. doi: 10.1016/j.xjon.2023.04.013. eCollection 2023 Sep.
Patients on ticagrelor undergoing urgent cardiac surgery are at high risk for perioperative bleeding complications. We sought to determine whether intraoperative hemoadsorption could remove ticagrelor and lower circulating drug concentrations.
The hemoadsorption device was incorporated in the cardiopulmonary bypass (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 (LabConnect). Data are presented as mean ± standard deviation.
A total of 11 patients undergoing urgent coronary artery bypass grafting at 3 institutions were included (mean age, 67.9 ± 9.9 years; 91% male; mean European System for Cardiac Operative Risk Evaluation II of 3.0 ± 3.3%; range, 0.7%-12.4%). Mean intraoperative hemoadsorption duration was 97.1 ± 43.4 minutes with a mean flow rate through the device of 422.9 ± 40.3 mL/min. Mean ticagrelor levels pre-CPB were 103.5 ± 63.8 ng/mL compared with mean post-CPB levels of 34.0 ± 17.5 ng/mL, representing a significant 67.1% reduction ( < .001). Intraoperative integration of the device was simple and safe without any device-related adverse events reported.
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 being evaluated in the double-blinded, randomized Safe and Timely Antithrombotic Removal-Ticagrelor (STAR-T) trial.
接受替格瑞洛治疗且需进行紧急心脏手术的患者围手术期出血并发症风险很高。我们试图确定术中血液吸附是否能够清除替格瑞洛并降低循环药物浓度。
血液吸附装置并入体外循环（CPB）回路，并在泵运行期间一直保持运行。在CPB前后采集血样。当前分析的主要目的是比较基线时血浆替格瑞洛平均总水平（ng/mL）与CPB结束时获得的替格瑞洛水平。血浆替格瑞洛水平在一家经认证的外部实验室（LabConnect）进行测量。数据以平均值±标准差表示。
共纳入了3家机构的11例接受紧急冠状动脉旁路移植术的患者（平均年龄67.9±9.9岁；91%为男性；平均欧洲心脏手术风险评估系统II评分为3.0±3.3%；范围为0.7%-12.4%）。术中血液吸附平均持续时间为97.1±43.4分钟，通过该装置的平均流速为422.9±40.3 mL/分钟。CPB前替格瑞洛平均水平为103.5±63.8 ng/mL，而CPB后平均水平为34.0±17.5 ng/mL，降幅达67.1%，差异有统计学意义（P<0.001）。该装置在术中的整合操作简单且安全，未报告任何与装置相关的不良事件。
这是首份体内研究报告，表明术中血液吸附能够有效清除替格瑞洛并显著降低循环药物水平。目前正在双盲、随机的“安全及时抗栓清除-替格瑞洛”（STAR-T）试验中评估主动清除替格瑞洛是否可减少接受紧急心脏手术患者围手术期的严重出血。
