Search

The use of unopposed oral anticoagulants while undergoing cardiothoracic surgery is associated with severe bleeding and increased morbidity. The aim of this experimental study was to examine if the apixaban concentration in reconstituted blood could be reduced in an in vitro setup by the use of CytoSorb whole blood adsorber, and to study how this affected global coagulation assays. An experimental study performed in a laboratory. An in vitro setup with reconstituted whole blood. Reconstituted whole blood spiked with apixaban circulated in an in vitro circuit with the CytoSorb 300 mL device connected. Blood samples were drawn at 0, 5, 15, 30, 60, and 120 minutes of adsorption. The apixaban concentration was measured at each time point. In addition, the global coagulation assays, thromboelastometry clotting time and thrombin generation, were performed, and the results were compared with baseline values obtained before spiking blood with apixaban. After 30 minutes of adsorption, the mean apixaban concentration was reduced from 414.3 (±69.1) ng/mL to 33 (±11.4) ng/mL. Thrombin generation showed maximum effect after 60 minutes, and the thromboelastometry clotting time was close to baseline values after 120 minutes. In this in vitro study, apixaban concentrations were effectively reduced, and the clotting time and thrombin generation assays were normalized by the use of CytoSorb whole blood adsorber. [ABSTRACT FROM AUTHOR]

Sepsis and septic shock affect anywhere between 100 and 1000/100,000 person-years and 19 per 100,000 person-years depending on the cohort studied, with mortality rates ranging between 20% and 50%. The recently updated Sepsis 3.0 consensus definitions state that sepsis is an infection accompanied by life-threatening organ dysfunction caused by a dysregulated host response. Given the pivotal role of cytokine production in sepsis and post major surgery, it follows that removal of these substances may attenuate the response particularly in the early phase of sepsis. [ABSTRACT FROM AUTHOR]

Introduction: The aim is to present a case of Lemierre's syndrome in a previously young and healthy girl, as well as to present an innovative way of its supportive treatment with extracorporeal blood purification. Lemierre's syndrome is characterized by septic thrombophlebitis of the internal jugular vein, anaerobic bacteremia, primarily caused by the bacterium Fusobacterium necrophorum, and the existence of a septic embolus. The syndrome typically initially manifests with oropharyngeal inflammation in previously healthy individuals. Case report: This paper presents the case of a young female patient who was treated at KBC Osijek at the Department of Maxillofacial Surgery. The patient presented with the anaerobic sepsis, thrombosis of the right jugular vein, presence of septic emboli in the lungs, and a right-sided parapharyngeal abscess, all of which manifested after her previous ambulatory treatment for tonsillopharyngitis. The patient underwent a complete open exploration of the retropharyngeal, parapharyngeal and retroesophageal space up to the aortic arch on the first day of hospitalization. Adequate drainage of purulent exudate was achieved. Intravenous antibiotic treatment with meropenem, linezolid and metronidazole as well as anticoagulant therapy with enoxaparin were started upon admission. On the second day of the hospitalization the patient was started with the extracorporeal blood purification method, which is not a common treatment modality for Lemierre's syndrome, as it is usually used for the treatment of Gram-negative sepsis. Microbiological analysis of the intraoperative sample isolated Fusobacterium necrophorum. The purpose of the extracorporeal blood purification is to use a special filtration membrane to eliminate pro-inflammatory cytokines and endotoxins from the blood and thus suppress the systemic inflammatory response and consequent multiorgan failure, which often leads to a fatal outcome. After complete antibiotic, anticoagulant and surgical therapy, with the help of extracorporeal blood purification, the patient was completely cured, and the thrombosed jugular vein was recanalized. [ABSTRACT FROM AUTHOR]

Copyright of Néphrologie & Thérapeutique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)