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Article

Potential Clinical Use of CytoSorb® for Ticagrelor and Rivaroxaban Elimination Prior to Emergency Orthopedic Surgery in Trauma Patients

by
Gabriele Melegari
1,*,
Fabio Gazzotti
1,
Federica Arturi
2,
Elisabetta Bertellini
3,
Andrea Tognù
4,
Domenico Pietro Santonastaso
5,
Matteo Villani
6,
Francesca Coppi
7,
Fabrizio Fattorini
8,
Fabio Catani
9 and
Alberto Barbieri
2
1
Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria, Policlinico di Modena, Via Del pozzo 71, 41121 Modena, Italy
2
School of Anaesthesia and Intensive Care, University of Modena and Reggio Emilia, 41125 Modena, Italy
3
School of Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy
4
Department of Anaesthesia and Intensive Care, Gaetano Pini Hospital, 20122 Milano, Italy
5
Department of Anaesthesia and Intensive Care, Bufalini Hospital, Azienda USL Romagna, 47521 Cesena, Italy
6
Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria, Policlinico di Parma, 56126 Pisa, Italy
7
Department of Cardiology, Azienda Ospedaliero Universitaria, Policlinico di Modena, 41121 Modena, Italy
8
Department of Anesthesia and Intensive Care, Ospedale San Sebastiano, 00044 Frascati, Italy
9
Department of Orthopedic Surgery, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria, Policlinico di Modena, 41121 Modena, Italy
*
Author to whom correspondence should be addressed.
Life 2025, 15(7), 1065; https://doi.org/10.3390/life15071065
Submission received: 6 June 2025 / Revised: 22 June 2025 / Accepted: 26 June 2025 / Published: 3 July 2025
(This article belongs to the Special Issue Advances in Anesthesia and Critical Care)
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Abstract

Background: Major orthopedic trauma in patients receiving anticoagulants such as ticagrelor or rivaroxaban poses a significant perioperative challenge, particularly in emergency contexts where bleeding risks are heightened and specific reversal agents may be unavailable. CytoSorb®, a hemoadsorption device, has demonstrated efficacy in cardiac surgery for drug removal. Its potential application in trauma surgery remains unexplored. Objective: This protocol describes a prospective clinical investigation assessing the feasibility and safety of CytoSorb® hemoadsorption for the preoperative removal of ticagrelor and rivaroxaban in trauma patients requiring urgent orthopedic surgery. Methods: The proposed intervention involves integrating CytoSorb® into a dedicated extracorporeal circuit under normothermic conditions (37 °C) with a blood flow of 150–200 mL/min for 300 min. Serial plasma samples will be collected at predefined intervals (0, 30, 60, 120, 240, 300 min) and drug concentrations. The primary outcome is the pharmacokinetic profile of drug clearance. Secondary endpoints include procedural safety, bleeding complications, and the feasibility of timely surgery. Expected Impact: The study aims to provide real-world data on the practical integration of CytoSorb® for anticoagulant removal in orthopedic trauma care, potentially facilitating earlier surgery and improving perioperative safety. Findings may inform future randomized trials and protocol standardization.
Keywords: CytoSorb®; trauma; ticagrelor; rivaroxoban; removal CytoSorb®; trauma; ticagrelor; rivaroxoban; removal

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MDPI and ACS Style

Melegari, G.; Gazzotti, F.; Arturi, F.; Bertellini, E.; Tognù, A.; Santonastaso, D.P.; Villani, M.; Coppi, F.; Fattorini, F.; Catani, F.; et al. Potential Clinical Use of CytoSorb® for Ticagrelor and Rivaroxaban Elimination Prior to Emergency Orthopedic Surgery in Trauma Patients. Life 2025, 15, 1065. https://doi.org/10.3390/life15071065

AMA Style

Melegari G, Gazzotti F, Arturi F, Bertellini E, Tognù A, Santonastaso DP, Villani M, Coppi F, Fattorini F, Catani F, et al. Potential Clinical Use of CytoSorb® for Ticagrelor and Rivaroxaban Elimination Prior to Emergency Orthopedic Surgery in Trauma Patients. Life. 2025; 15(7):1065. https://doi.org/10.3390/life15071065

Chicago/Turabian Style

Melegari, Gabriele, Fabio Gazzotti, Federica Arturi, Elisabetta Bertellini, Andrea Tognù, Domenico Pietro Santonastaso, Matteo Villani, Francesca Coppi, Fabrizio Fattorini, Fabio Catani, and et al. 2025. "Potential Clinical Use of CytoSorb® for Ticagrelor and Rivaroxaban Elimination Prior to Emergency Orthopedic Surgery in Trauma Patients" Life 15, no. 7: 1065. https://doi.org/10.3390/life15071065

APA Style

Melegari, G., Gazzotti, F., Arturi, F., Bertellini, E., Tognù, A., Santonastaso, D. P., Villani, M., Coppi, F., Fattorini, F., Catani, F., & Barbieri, A. (2025). Potential Clinical Use of CytoSorb® for Ticagrelor and Rivaroxaban Elimination Prior to Emergency Orthopedic Surgery in Trauma Patients. Life, 15(7), 1065. https://doi.org/10.3390/life15071065

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