Panholzer Bernd, Nowak-Goettl Ulrike, Huenges Katharina, Sommer Wiebke
Department of Cardiac Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel, Schleswig-Holstein, Germany.
Thorac Cardiovasc Surg Rep. 2025 Sep 15;14(1):e24-e28. doi: 10.1055/a-2682-8640. eCollection 2025 Jan.
In patients on direct oral anticoagulants (DOAC), emergency surgery is characterized by the occurrence of a massively increased tendency to bleed. Currently, there is no approved antidote for postoperative patients, making specific therapy challenging in these situations.
Emergency surgery was required for a 72-year-old male patient who was in cardiogenic shock due to severe aortic regurgitation resulting from acute prosthetic valve endocarditis. Due to atrial fibrillation, the patient was on apixaban, a factor Xa (FXa) inhibitor anticoagulant, until surgery. We used the ADVanced Organ Support (ADVOS) albumin hemodialysis system postoperatively to treat persisting shock with multi-organ failure, acidosis, and DOAC removal. Serial drug-level measurements revealed strongly accelerated apixaban clearance. In line with this, we observed only moderate drainage losses.
ADVOS accelerates the removal of apixaban and is a promising therapy for preventing bleeding complications in patients receiving DOAC therapy after emergency surgery.
在接受直接口服抗凝剂（DOAC）治疗的患者中，急诊手术的特点是出血倾向大幅增加。目前，术后患者尚无获批的解毒剂，这使得在这些情况下进行特异性治疗具有挑战性。
一名72岁男性患者因急性人工瓣膜心内膜炎导致严重主动脉瓣反流而发生心源性休克，需要进行急诊手术。由于房颤，该患者在手术前一直服用阿哌沙班，一种Xa因子（FXa）抑制剂抗凝剂。我们在术后使用了高级器官支持（ADVOS）白蛋白血液透析系统来治疗持续存在的休克伴多器官功能衰竭、酸中毒以及清除DOAC。连续的药物水平测量显示阿哌沙班清除速度明显加快。与此一致的是，我们仅观察到中度引流损失。
ADVOS可加速阿哌沙班的清除，是预防急诊手术后接受DOAC治疗患者出血并发症的一种有前景的治疗方法。
