Randomized pilot trial of intraoperative hemoadsorption in clopidogrel treated patients undergoing urgent coronary artery bypass grafting
6 affiliations
- 1National Heart Center, Royal Hospital
- 2Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences
- 3Cardiac anesthesia consultant, National Heart Centre, Royal hospital
- 4CytoSorbents Europe GmbH
- 5CytoSorbents Inc
- 6Department of Cardiac Surgery, Shariati Hospital, Tehran University of Medical Sciences
Abstract
Background Patients receiving clopidogrel who undergo urgent CABG before the recommended 5-day washout period are at increased risk of perioperative bleeding. This study evaluated whether intraoperative hemoadsorption can reduce bleeding in such patients. Methods Patients undergoing CABG within 24 h 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 median 24-hr CTD of 300mL [250–400] vs. 500mL [400–700], p = 0.0003, transfusions of packed red blood cells 0 [0–1] vs. 1 [0–2] units, p = 0.047), fresh frozen plasma 0 [0–0] vs. 2 [2–3] units, p < 0.0001) and platelets 0 [0–0] vs. 2 [1–3] units, p < 0.0001 compared with Group 2. One revision for bleeding control occurred in Group 2 (4.0%). No device-related serious adverse events were observed. Conclusion In this cohort of clopidogrel-treated patients undergoing CABG within 24 h of discontinuation, intraoperative hemoadsorption was associated with lower postoperative bleeding and transfusion requirements.
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BibTeX
@article{jahangirifard2026randomized,
title = {{Randomized pilot trial of intraoperative hemoadsorption in clopidogrel treated patients undergoing urgent coronary artery bypass grafting}},
author = {Alireza Jahangirifard and Seyed Bashir Mirtajani and Is´haq Al-Aamri and Kumait Al-Lawati and Mandana Hosseinzadeh and Daniel Wendt and Efthymios N. Deliargyris and Mohammad Hossein Mandegar},
journal = {Journal of Cardiothoracic Surgery},
year = {2026},
month = jul,
doi = {10.1186/s13019-026-04607-7},
url = {https://doi.org/10.1186/s13019-026-04607-7},
note = {CC BY},
}
RIS
TY - JOUR
TI - Randomized pilot trial of intraoperative hemoadsorption in clopidogrel treated patients undergoing urgent coronary artery bypass grafting
AU - Alireza Jahangirifard
AU - Seyed Bashir Mirtajani
AU - Is´haq Al-Aamri
AU - Kumait Al-Lawati
AU - Mandana Hosseinzadeh
AU - Daniel Wendt
AU - Efthymios N. Deliargyris
AU - Mohammad Hossein Mandegar
PY - 2026
DA - 2026/07/01
JO - Journal of Cardiothoracic Surgery
DO - 10.1186/s13019-026-04607-7
UR - https://doi.org/10.1186/s13019-026-04607-7
AB - Background Patients receiving clopidogrel who undergo urgent CABG before the recommended 5-day washout period are at increased risk of perioperative bleeding. This study evaluated whether intraoperative hemoadsorption can reduce bleeding in such patients. Methods Patients undergoing CABG within 24 h 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 median 24-hr CTD of 300mL [250–400] vs. 500mL [400–700], p = 0.0003, transfusions of packed red blood cells 0 [0–1] vs. 1 [0–2] units, p = 0.047), fresh frozen plasma 0 [0–0] vs. 2 [2–3] units, p < 0.0001) and platelets 0 [0–0] vs. 2 [1–3] units, p < 0.0001 compared with Group 2. One revision for bleeding control occurred in Group 2 (4.0%). No device-related serious adverse events were observed. Conclusion In this cohort of clopidogrel-treated patients undergoing CABG within 24 h of discontinuation, intraoperative hemoadsorption was associated with lower postoperative bleeding and transfusion requirements.
SN - 1749-8090
ER -