Randomized, controlled trial of intraoperative hemadsorption to reduce bleeding in patients on clopidogrel undergoing urgent coronary artery bypass grafting

Background: Patients on clopidogrel undergoing urgent coronary artery bypass grafting (CABG) before completing the recommended 5-day washout are at risk of perioperative bleeding. A novel hemoadsorption device that removes antithrombotic drugs has been shown to reduce bleeding in patients undergoing CABG within 2 days of ticagrelor discontinuation. The current study evaluated the effectiveness of intraoperative hemoadsorption in reducing bleeding in patients on clopidogrel undergoing urgent CABG. Methods: Patients undergoing CABG within 24 hours of clopidogrel discontinuation were randomized 1:1 to intraoperative hemoadsorption (Group 1) or control (Group 2). In the intervention group, the device was incorporated into the cardiopulmonary bypass (CPB) circuit. Efficacy was assessed by 24-hour chest tube drainage (CTD), blood product transfusions and surgical revisions for bleeding control. Results: A total of 50 patients were randomized (mean age 64±8.6 years, 82% male). There were no differences in baseline characteristics between groups. Group 1 showed significantly reduced 24-hr CTD (332±189 vs. 586±285 mL, p=0.038), transfusions of packed red blood cells (0.5±0.3 vs. 1.2±0.6 units, p=0.027), fresh frozen plasma (0.2±0.1 vs. 2.2±0.1 units, p<0.001) and platelets (0.16±0.1 vs. 2.1±0.9 units, p=0.001) compared with Group 2. One revision for bleeding control occurred in Group 2 (4.0%). No device-related serious adverse events were observed. Conclusion: Intraoperative hemadsorption significantly reduces CTD volumes and blood product transfusions after CABG in patients on clopidogrel operated within 24 hours of discontinuation.