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Beitragstitel Effect of cytoadsorbant device on coagulation factors during cardio-pulmonary bypass
Autor:innen
  1. Elettra Poli CHUV Lausanne Präsentierende:r
  2. Lorenzo Alberio CHUV Centre hospitalier universitaire vaudois
  3. Anna Bauer Dörries Ensemble Hospitalier de la Côte
  4. Carlo Marcucci CHUV Centre hospitalier universitaire vaudois
  5. Aurélien Roumy CHUV Centre hospitalier universitaire vaudois
  6. Matthias Kirsch Lausanne University Hospital and University of Lausanne
  7. Eleonora De Stefano CHUV Centre hospitalier universitaire vaudois
  8. Lucas Liaudet Centre Hospitalier Universitaire Vaudois (CHUV)
  9. Antoine Schneider CHUV Centre Hospitalier Universitaire Vaudois (CHUV)
Präsentationsform Freie Mitteilung
Themengebiete
  • SGI Ärzteschaft | SSMI médecins
Abstract-Text Context and Objectives:
Cytokines Hemoadsorption (HA) might improve outcomes of patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). However, the effect of HA on coagulation factors remains unknown. This sub study nested within a randomized control trial comparing HA with standard of care (NCT02775123) aims at evaluating the effect of a cytoadsorbant device on coagulation factors activity.

Methods:
22 elective cardiac surgery patients were randomly assigned to either standard CPB (control group, n = 12) or CPB plus Cytosorb® (Cytosorbents, NJ, USA) (Cytosorb group, n = 10). The activity of coagulation factors [Antithrombin (AT), Von Willebrand Factor (VWF), Factor II, V, VIII, IX, XI, and XII] were measured in both groups at T0 (after induction of anaesthesia), T2 (end of CPB, after protamine administration), T3 (6 hours after CPB initiation), T4 (24 hours after CPB initiation). In the HA group, an additional measure was performed at T1 (60 minutes after CPB initiation) before and after the HA device.

Results:
Patients’ mean age was 63.9 ± 17.7 years, 77.3% were male, and mean EuroSCORE II was 6.1 ± 6.5. Procedures were coronary artery bypass graft (CABG) or single valve replacement (4/22), double valve replacement (1/22), CABG combined with valve replacement (7/22) and aortic root replacement (10/22). Median CPB duration was 139 (105-194) min.
Post-device AT and FII activity was significantly lower (respectively from 70.4 to 66.6, p = 0.01 and from 61.5 to 57.1, p = 0.03) compared to pre-device measurement. This was not the case for the other coagulation factors. During CPB (T0 to T2), observed changes in the activity of coagulation factors were similar between the Cytosorb and the control group. In the post-CPB period (T2 to T3), a slight decrease in the activity of FII and AT and a slight increase in VWF was observed in the HA group.
There was no difference in post-operative PT, aPTT, platelet counts, haemoglobin or need for blood product transfusion between the two groups. Protamin/heparin ratio was significantly lower in the HA group [0.45 ± 0.16 vs 0.7 ± 0.2 (control), p = 0.02].

Conclusion:
HA with Cytosorb® was associated with minor and non-clinically significant changes in coagulation factors activity. These changes did not influence conventional coagulation parameters nor the need for RBC or platelets transfusion. HA was associated with a decreased protamin/heparin ratio consistent with heparin adsorption in the device.