Table 2 Findings of the literature review

Røed-Undlien, et al. (2022) [14]

Experimental Study:

Laboratory Case-study

In-Vitro

“Examine if the apixaban concentration in blood could be reduced … by the use of Cytosorb” -Apixaban concentration was measured at 0,5,15,30,60 and 120 minutes of absorption.

- After 30 minutes, the mean apixaban concentration was reduced from 414.3 (±69.1) ng/mL to 33 (±11.4) ng/mL.

Apixaban concentrations were effectively reduced, and the clotting time and thrombin generation assays were normalized by the use of Cytosorb^®.

Mendes, et al. (2021) [6]

Observational Study: Case report

In-Vivo

83-Year-old women treated with apixaban underwent emergent redo mitral valve replacement for prothestic valve endocarditis.

- After 100 minutes of CPB, 50% AFXaA rate decrease was observed as compared to pre-CPB values.

- 39% and 44% reductions of AFXaA levels in comparison to the expected levels in patients with normal or alterad renal function, respectively.

Cytosorb^® cartridge in the CPB was safe and associated with rapid correction of Apiyaban-associated anticoagulation.

Buonocore, et al. (2022) [15]

Observational Study: Case report

In-Vivo

81-year-old male patient, haemodynamic unstable, with prosthetic aortic valve endocarditis on apixaban therapy.

-Direct measurement of pre-adsorber inlet and post-adsorber outlet apixaban plasma levels showed a rapid and sustained decrease of the drug through the adsorber.

Cytosorb^® proved to be effective for removal of apixaban in emergency surgery setting by direct measurements of drugs levels before and during CPB circulation.

Hassan, et al. (2022) [16]

Observational Study: Case-Control

In-Vivo

25 patients undergoing cardiac surgery who were also on concurrent therapy with apixaban;

Control Group (n=12) and Cytosorb^® Group (n=13).

Cytosorb^® group:

-No bleeding events and no repeat-thoracotomies occurred;

Post-op 24h volume was significantly lower (510±152 vs. 893±579 ml, p=0.03);

-No need of DDAVP (0 vs 10±13.6 mg, p=0.01).

Use of hemadsorption in patient on apixaban undergoing emergent cardiac surgery, was feasible and safe.

Compared to control group, bleeding complications did not occur and the need for 24 h chest-tube-drainage and 1-deamino-8-d-arginine-vasopressin (DDAVP) to achieve hemostasis, was significantly lower on Cytosorb^® group.

Dalmastri, et al. (2023) [17]

Observational Study: Case-report

In-Vivo

82-year-old male patient, with AKI in the context of severe bilateral hydroureteronephrosis and other comorbidities, on apixaban therapy due to atrial fibrillation.

-After 2h30 minutes of CRRT with Cytosorb^®, there was a good reduction of apixaban from 139 to 72 ng/ml (reduction rate of 48.2%) registered. This allowed for an easy placement of bilateral nephrostomies without complications.

Combined treatment with CRRT and Cytosorb^® was associated with the rapid and effective removal of Apixaban.