Schmitto Jan, De Somer Filip, Thielmann Matthias, Marczin Nandor, Ruhparwar Arjang, Meyer Anna L, Hagl Christian, Matejic-Spasic Marijana, Wendt Daniel, Fan Weihong, Deliargyris Efthymios N, Storey Robert F, Schmoeckel Michael
Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Heart Centre, Ghent University Hospital, Ghent, Belgium.
JHLT Open. 2025 Aug 20;10:100369. doi: 10.1016/j.jhlto.2025.100369. eCollection 2025 Nov.
Patients on heart transplant waiting lists are often on antithrombotic (AT) drugs. Emergency orthotopic heart transplantation (OHT) when performed on such patients without optimal washout periods increases the risk of severe perioperative bleeding. Intraoperative AT removal by hemoadsorption may mitigate excess bleeding risks.
The international Safe and Timely Antithrombotic Removal (STAR) registry captures real-world outcomes (ClinicalTrials.gov# NCT05077124). Included patients were on ticagrelor or direct-acting oral anticoagulants (DOACs) undergoing emergent OHT. Hemoadsorption was integrated into the cardiopulmonary bypass (CPB) circuit. Bleeding was assessed with the universal definition of perioperative bleeding (UDPB) and volume of chest tube drainage (CTD).
Seven patients were included (3 ticagrelor, 2 apixaban, 2 dabigatran; mean age 39.1 ± 11.1 years; 4 females). Mean time from the last AT dose to surgery was 29.4 ± 13.4 hours. Mean CPB duration was 206.0 ± 56.9 minutes with a mean device flow of 340 ± 126 ml. There were no massive bleeding events (UDPB 4), surgical revisions to control bleeding, or deaths within 30 days. Severe bleeding (UDPB 3) occurred in 1/7 (14.3%). Mean 12-hour and 24-hour CTD were 385.7 ± 263.4 m and 586.1 ± 315.0 ml, respectively. No device-related adverse events were reported.
This case series from the ongoing STAR registry shows that intraoperative AT removal is simple and potentially effective in minimizing serious perioperative bleeding in patients on ticagrelor or DOACs undergoing OHT. Prospective, controlled studies in larger cohorts are needed to validate these promising observations.
心脏移植等待名单上的患者通常在服用抗血栓（AT）药物。在此类患者未经过最佳洗脱期就进行急诊原位心脏移植（OHT）会增加围手术期严重出血的风险。通过血液吸附在术中去除AT可能会降低出血风险。
国际安全及时抗血栓清除（STAR）注册研究记录了实际治疗效果（ClinicalTrials.gov编号：NCT05077124）。纳入的患者为正在服用替格瑞洛或直接口服抗凝剂（DOAC）且接受急诊OHT的患者。血液吸附被整合到体外循环（CPB）回路中。采用围手术期出血通用定义（UDPB）和胸管引流量（CTD）评估出血情况。
共纳入7例患者（3例服用替格瑞洛，2例服用阿哌沙班，2例服用达比加群；平均年龄39.1±11.1岁；4例女性）。从最后一次服用AT到手术的平均时间为29.4±13.4小时。平均CPB持续时间为206.0±56.9分钟，平均设备流量为340±126毫升。未发生大出血事件（UDPB 4级）、为控制出血而进行的手术修正或30天内死亡。1/7（14.3%）的患者发生严重出血（UDPB 3级）。12小时和24小时的平均CTD分别为385.7±263.4毫升和586.1±315.0毫升。未报告与设备相关的不良事件。
来自正在进行的STAR注册研究的该病例系列表明，术中去除AT操作简单，对于服用替格瑞洛或DOAC且接受OHT的患者，在最大程度减少围手术期严重出血方面可能有效。需要在更大队列中进行前瞻性对照研究以验证这些有前景的观察结果。
