Download PDF
Open Access
CC BY 4.0 · Thorac Cardiovasc Surg Rep 2025; 14(01): e24-e28
DOI: 10.1055/a-2682-8640
Case Report: Cardiac

Accelerated Apixaban Removal by Using the ADVanced Organ Support (ADVOS) Albumin Hemodialysis System—A Case Report

Authors

  • Bernd Panholzer

    1   Department of Cardiac Surgery, University Hospital Schleswig-Holstein, Kiel, Germany

  • Ulrike Nowak-Goettl

    2   Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel, Schleswig-Holstein, Germany

  • Katharina Huenges

    1   Department of Cardiac Surgery, University Hospital Schleswig-Holstein, Kiel, Germany

  • Wiebke Sommer

    1   Department of Cardiac Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
Further Information
Also available at
  Permissions and Reprints
Preview

Abstract

Background

In patients on direct oral anticoagulants (DOAC), emergency surgery is characterized by the occurrence of a massively increased tendency to bleed. Currently, there is no approved antidote for postoperative patients, making specific therapy challenging in these situations.

Case Description

Emergency surgery was required for a 72-year-old male patient who was in cardiogenic shock due to severe aortic regurgitation resulting from acute prosthetic valve endocarditis. Due to atrial fibrillation, the patient was on apixaban, a factor Xa (FXa) inhibitor anticoagulant, until surgery. We used the ADVanced Organ Support (ADVOS) albumin hemodialysis system postoperatively to treat persisting shock with multi-organ failure, acidosis, and DOAC removal. Serial drug-level measurements revealed strongly accelerated apixaban clearance. In line with this, we observed only moderate drainage losses.

Conclusion

ADVOS accelerates the removal of apixaban and is a promising therapy for preventing bleeding complications in patients receiving DOAC therapy after emergency surgery.

Keywords

cardiogenic shock - direct oral anticoagulants - cardiac surgery - extracorporeal organ support

License Type: CC-BY




Publication History

Received: 01 July 2024

Accepted: 02 September 2024

Accepted Manuscript online:
14 August 2025

Article published online:
15 September 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany