Low Bleeding after Emergency CABG Using CytoSorb Adsorption of Ticagrelor: A 2-Year Clinical Experience

Objectives: Patients with acute coronary syndrome (ACS) and the indication for emergency coronary artery bypass grafting (CABG) while under treatment with the P2Y12 receptor antagonist ticagrelor have a high risk for serious bleeding. A clinical benefit of intraoperative ticagrelor removal using Cytosorb adsorption (CytoSorbents Inc., USA) has been described recently.

Methods: We investigated 55 consecutive patients (age: 65 ± 12 years) with ACS who underwent isolated emergency CABG at our institution between July 2017 and July 2019. All patients were on therapy with ticagrelor. We routinely installed standardized Cytosorb adsorption into the heart–lung–machine. Bleeding complications during and after surgery were analyzed in detail.

Results: All procedures were carried out as isolated CABG with the use of both thoracic arteries in 65.5% of patients for complete arterial revascularizations (n = 36). Ticagrelor adsorption was performed during cardiopulmonary bypass (CPB) time of 103 ± 35 min. Mean drainage volume over 24 hours was 480 ± 211 mL; only one rethoracotomy (1.8%) for surgical bleeding had to be performed. Mean length of stay in the intensive care unit was 2 ± 3 days and total length of hospital stay 12 ± 5 days. In the majority of patients, no transfusion of blood products was needed (80.0% without red blood cell transfusion [n = 44], 69.1% [n = 38] without platelet transfusion). Rate of 30-day mortality was 1.8%.

Conclusion: The use of Cytosorb adsorption in ticagrelor-loaded patients who undergo emergency CABG for ACS is a safe and effective method that provides a very low rate of bleeding complications.