{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:41:57Z","timestamp":1760035317301,"version":"build-2065373602"},"reference-count":37,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,7,3]],"date-time":"2025-07-03T00:00:00Z","timestamp":1751500800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Major orthopedic trauma in patients receiving anticoagulants such as ticagrelor or rivaroxaban poses a significant perioperative challenge, particularly in emergency contexts where bleeding risks are heightened and specific reversal agents may be unavailable. CytoSorb\u00ae, a hemoadsorption device, has demonstrated efficacy in cardiac surgery for drug removal. Its potential application in trauma surgery remains unexplored. Objective: This protocol describes a prospective clinical investigation assessing the feasibility and safety of CytoSorb\u00ae hemoadsorption for the preoperative removal of ticagrelor and rivaroxaban in trauma patients requiring urgent orthopedic surgery. Methods: The proposed intervention involves integrating CytoSorb\u00ae into a dedicated extracorporeal circuit under normothermic conditions (37 \u00b0C) with a blood flow of 150\u2013200 mL\/min for 300 min. Serial plasma samples will be collected at predefined intervals (0, 30, 60, 120, 240, 300 min) and drug concentrations. The primary outcome is the pharmacokinetic profile of drug clearance. Secondary endpoints include procedural safety, bleeding complications, and the feasibility of timely surgery. Expected Impact: The study aims to provide real-world data on the practical integration of CytoSorb\u00ae for anticoagulant removal in orthopedic trauma care, potentially facilitating earlier surgery and improving perioperative safety. Findings may inform future randomized trials and protocol standardization.<\/jats:p>","DOI":"10.3390\/life15071065","type":"journal-article","created":{"date-parts":[[2025,7,3]],"date-time":"2025-07-03T06:54:16Z","timestamp":1751525656000},"page":"1065","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Potential Clinical Use of CytoSorb\u00ae for Ticagrelor and Rivaroxaban Elimination Prior to Emergency Orthopedic Surgery in Trauma Patients"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4512-4835","authenticated-orcid":false,"given":"Gabriele","family":"Melegari","sequence":"first","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria, Policlinico di Modena, Via Del pozzo 71, 41121 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabio","family":"Gazzotti","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria, Policlinico di Modena, Via Del pozzo 71, 41121 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federica","family":"Arturi","sequence":"additional","affiliation":[{"name":"School of Anaesthesia and Intensive Care, University of Modena and Reggio Emilia, 41125 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabetta","family":"Bertellini","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8840-4872","authenticated-orcid":false,"given":"Andrea","family":"Togn\u00f9","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Gaetano Pini Hospital, 20122 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1304-7724","authenticated-orcid":false,"given":"Domenico Pietro","family":"Santonastaso","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Bufalini Hospital, Azienda USL Romagna, 47521 Cesena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4269-6096","authenticated-orcid":false,"given":"Matteo","family":"Villani","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria, Policlinico di Parma, 56126 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7715-6941","authenticated-orcid":false,"given":"Francesca","family":"Coppi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Azienda Ospedaliero Universitaria, Policlinico di Modena, 41121 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabrizio","family":"Fattorini","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, Ospedale San Sebastiano, 00044 Frascati, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabio","family":"Catani","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria, Policlinico di Modena, 41121 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Barbieri","sequence":"additional","affiliation":[{"name":"School of Anaesthesia and Intensive Care, University of Modena and Reggio Emilia, 41125 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2040","DOI":"10.1016\/j.injury.2019.09.011","article-title":"Impact of oral anticoagulation on proximal femur fractures treated within 24\u2009h-A retrospective chart review","volume":"50","author":"Schuetze","year":"2019","journal-title":"Injury"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1016\/j.amjmed.2020.01.002","article-title":"Association of Reversal of Anticoagulation Preoperatively on 30-Day Mortality and Outcomes for Hip Fracture Surgery","volume":"133","author":"Yoo","year":"2020","journal-title":"Am. 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