Abstract 12901: Removal of Dabigatran Using Sorbent Hemadsorption

• Published in: Circulation (New York, N.Y.) Vol. 132; no. Suppl_3 Suppl 3; p. A12901
• Main Authors: Angheloiu, George O, van Ryn, Joanne, Goss, Ashley M
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 10.11.2015
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.132.suppl_3.12901

BackgroundDabigatran is a direct thrombin inhibitor that has been demonstrated to be superior to warfarin in protecting against stokes in patients with atrial fibrillation. The risk of a major bleed is lower with dabigatran than with warfarin, however 1.5% of patients treated with the former drug experience gastro-intestinal bleeding episodes versus 1.02% per year for warfarin. While a reversal agent for Dabigatran has been developed, we designed and tested an alternative removal method that in addition to novel anticoagulants can remove antiplatelets (100% removal rate of Ticagrelor from blood; results submitted in parallel abstract) and radiocontrast agents (96% removal rate), two other classes of agents frequently used in cardiology and known to lead to unwanted events such as bleeding or acute kidney injury respectively.HypothesisDabigatran can be adsorbed by Cytosorb sorbent beads.MethodsWe performed first-pass bench experiments using a mix of 0.35 mg of Dabigatran in 1000 ml 4% bovine serum albumin (BSA) saline solution rendering a dilution of 350 ng/ml similar with therapeutic concentration levels of Dabigatran in patients with non-valvular atrial fibrillation. 100 ml solution was passed through 10 ml, 20 ml and 40 ml sorbent at an injection rate of 1 ml/min for 100 minutes. Dabigatran concentration was measured in the affluent and effluent solution using a liquid chromatography technique with tandem mass spectrometric detection (LC/MS/MS).ResultsThe Dabigatran removal rate was 100% using a 40 cc column of Cytosorb, and approximately 94% with the 10 ml and 20 ml columns.ConclusionSorbent adsorption demonstrates robust removal of Dabigatran from BSA solution. This creates the premises of an all-including method possibly able to remove three classes of agents frequently used in cardiologyanticoagulants, antiplatelets and radiocontrast agents.