CytoSorb for reducing risk of bleeding during cardiac surgery

The technology described in this briefing is CytoSorb. It is used for the removal of the blood thinning medication, ticagrelor, from blood during on-pump urgent or emergency cardiac surgery.

The innovative aspects are that it is the first medical device that can be used to remove ticagrelor from the blood during urgent or emergency cardiac surgery. Using CytoSorb in emergency cardiac surgery could reduce resource use for management of bleeding complications, and in urgent cardiac surgery could reduce length of hospital stay before the procedure and the use of adjunctive bridging treatments.

The intended place in therapy would be as an alternative to surgical management of bleeding in emergency surgeries (when ticagrelor is not removed) or as an alternative to a 5- to 7‑day delay in urgent surgeries for natural ticagrelor washout.

The main points from the evidence summarised in this briefing are from 6 studies (4 observational studies, 1 bootstrap analysis based on a retrospective case series and 1 case study) including a total of 209 people. They show that CytoSorb may be more effective than no CytoSorb adsorption in people having cardiac surgery.

Key uncertainties around the evidence or technology are that 3 small comparative observational studies focusing on emergency cardiac surgery were included. In most studies people were given ticagrelor or rivaroxaban. No comparative studies were included for people having urgent cardiac surgery. None of the studies were done in the UK.

The cost of CytoSorb is £1,500 per unit (excluding VAT). The resource impact would be less than standard care for emergency cardiac surgery (a UK cost‑utility analysis reported a cost saving of £3,941 for CytoSorb compared with no removal of ticagrelor), and less than standard care for urgent surgery (about £1,575).