Ticagrelor Hemoadsorption Using Cytosorb® for Reduction of Bleeding During Cardiac Surgery

Inclusion criteria

• Patient or patient's representative having read and understood the information letter and signed the consent form
• Age ≥ 18 y/o
• Ticagrelor administration within 48 hours prior to surgery
• Cardiac surgery with cardiac bypass
• Patient affiliated with, or beneficiary of a social security (health insurance) category.
• Women of childbearing potential (a woman is considered of childbearing potential (WOCBP), i.e. fertile, following menarche and until becoming post-menopausal unless permanently sterile):

• with effective contraception (Cf. CTCG) (progestogen-only oral hormonal contraception, where inhibition of ovulation is not the primary mode of action, male or female condom with or without spermicide, cap, diaphragm or sponge with spermicide) since 1 month, during study period
• negative blood pregnancy test by b-HCG at inclusion.
• Women permanently sterile (hysterectomy, bilateral salpingectomy and bilateral oophorectomy)
• Postmenopausal women: A postmenopausal state is defined as no menses for 12 months without an alternative medical cause. A high follicle stimulating hormone (FSH) level in the postmenopausal range may be used to confirm a post-menopausal state in women not using hormonal contraception or hormonal replacement therapy. However in the absence of 12 months of amenorrhea, a single FSH measurement is insufficient.

Exclusion criteria

• Concomitant antiplatelet drugs or ongoing anticoagulants other than aspirin and heparin
• Ongoing systemic infection (including active endocarditis)
• Ongoing treatment with an antibiotic or antifungal at high risk of removal by Cytosorb®: teicoplanin, vancomycin, linezolid, gentamycin, amphotericin B liposomal, azole drugs or fluconazole
• Ongoing treatment with an anticonvulsant at high risk of removal by Cytosorb®: phenytoin, phenobarbital or valproic acid.
• Contraindications to Cytosorb® (known preoperative platelet count < 20 000/mm3, Sickle cell disease crisis, history to heparin-induced thrombopenia, body mass index ≥ 40 kg/m², hypersensitivity to a component, Any pre-existing contraindication to extracorporeal therapy (CPB))
• Cardiac surgery for ventricle assistance device or transplantation
• Preoperative critical state
• Chronic pathology with life expectancy less than 1 month
• Pregnant or breastfeeding women and women of child-bearing age not using effective means of contraception
• Absence of affiliation to a social security program
• Person deprived of liberty by an administrative or judiciary decision or person placed under judicial protection, under guardianship or supervision
• Person consenting to the research participating having participated to another trial within a period of one week
• Person participating to another interventional research