Ticagrelor and Rivaroxaban Elimination With Cytosorb Adsorber Before Urgent Off-Pump Coronary Bypass.

Abstract Cytosorb hemoadsorption (CytoSorbents Inc., USA) was performed shortly before an urgent off pump coronary arterial bypass (OPCAB) operation in a 58 years old male at high risk of bleeding due to treatment of coronary artery disease with ticagrelor and atrial fibrillation with rivaroxaban. The patient had dissection of the left anterior descending artery during a percutaneous coronary intervention. Preoperatively, Cytosorb hemoadsorption was applied to eliminate the coagulative active medications. His intra- and postoperative course was uneventful with adequate bleeding control. This case highlights a novel approach for managing antiplatelet drugs and anticoagulants such as ticagrelor and rivaroxaban prior to OPCAB.