Accelerated Apixaban Removal by Using the ADVanced Organ Support (ADVOS) Albumin Hemodialysis System-A Case Report.

IF 0.3 Q4 SURGERY

Thoracic and Cardiovascular Surgeon Reports Pub Date : 2025-09-15 eCollection Date: 2025-01-01 DOI:10.1055/a-2682-8640

Bernd Panholzer, Ulrike Nowak-Goettl, Katharina Huenges, Wiebke Sommer

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Abstract

Background: 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.

Case description: 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.

Conclusion: ADVOS accelerates the removal of apixaban and is a promising therapy for preventing bleeding complications in patients receiving DOAC therapy after emergency surgery.

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先进器官支持（ADVOS）白蛋白血液透析系统加速阿哌沙班清除一例报告。

背景：在直接口服抗凝剂（DOAC）的患者中，急诊手术的特点是出血倾向大量增加。目前，还没有批准用于术后患者的解毒剂，这使得在这些情况下进行特异性治疗具有挑战性。病例描述：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反流而发生心源性休克，需要紧急手术治疗。由于心房颤动，患者一直服用阿哌沙班，一种Xa因子（FXa）抑制剂抗凝剂，直到手术。我们术后使用先进器官支持（ADVOS）白蛋白血液透析系统治疗伴有多器官功能衰竭、酸中毒和DOAC去除的持续性休克。一系列药物水平测量显示阿哌沙班清除率明显加快。与此一致，我们只观察到适度的排水损失。结论：ADVOS加速了阿哌沙班的清除，是预防急诊手术后接受DOAC治疗的患者出血并发症的一种有希望的治疗方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Thoracic and Cardiovascular Surgeon Reports SURGERY-

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