The effect of hemoadsorption on rivaroxaban blood plasma concentration in emergency cardiac surgery

Abstract

Hemoadsorption was used in a 59-year-old patient with an acute type A aortic dissection, who was on rivaroxaban and dual antiplatelet therapy with clopidogrel and acetylsalicylic acid. Our aim was to expeditiously remove rivaroxaban preoperatively. After 8 h of hemoadsorption, the rivaroxaban blood plasma concentration (RBPC) did not decrease below 42.1 μg/l. Intraoperatively, hemoadsorption was repeated during extracorporeal circulation. Sixteen hours after surgery and a total of 13 h of hemoadsorption, the RBPC was 40.1 μg/l. Thereafter, the RBPC spontaneously decreased to 24.7 μg/l within 14 h. In our patient, hemoadsorption may have enhanced rivaroxaban removal at higher RBPC (cutoff value 40-50 μg/l). At lower RBPC, the removal of rivaroxaban may depend solely on the natural drug elimination process. The evolution of the RBPC under hemoadsorption in vivo warrants a thorough investigation. Further clinical studies are required to assess the effectiveness and limitations of hemoadsorption to preclude a fatal bleeding event in patients with rivaroxaban in need of major emergency surgery.

Keywords: DOAC; Emergency cardiac surgery; Hemoadsorption; Rivaroxaban; Type A aortic dissection.

Fig. 1

Evolution of rivaroxaban and creatinine blood plasma concentration over time. First values were measured at admission to our hospital—7 h after the administration of 20 mg rivaroxaban (RXA). #1 Hemoadsorption period preoperatively during intensive care (ICU). #2 Hemoadsorption period during surgery (OR)