Abstract
Background: Dabigatran 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. Hypothesis: Dabigatran can be adsorbed by Cytosorb sorbent beads. Methods: We 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). Results: The Dabigatran removal rate was 100% using a 40 cc column of Cytosorb, and approximately 94% with the 10 ml and 20 ml columns. Conclusion: Sorbent 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 cardiology: anticoagulants, antiplatelets and radiocontrast agents.
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