
Prof. Daniel Wendt on the results of the second interim STAR Registry analysis

“Hemoadsorption appears to be a feasible, safe and potentially effective solution for reducing perioperative bleeding in patients on oral anticoagulants”
Prof. Daniel Wendt on the results of the second interim STAR Registry analysis
Harriet Adamson: “So Dr Wendt, let´s talk about antithrombotic drugs – what´s important and why could they cause problems?”
Daniel Wendt: “Antithrombotic drugs are widely used to treat people with heart and blood vessel conditions. Millions of people around the world take direct oral anticoagulants (DOACs), such as rivaroxaban, apixaban, edoxaban, and dabigatran, to prevent strokes and treat blood clots in the veins. However, complications arise when these patients need urgent or emergency surgery. Guidelines suggest stopping DOACs at least 48 hours before surgery to let the medication clear from the body, but sometimes there isn’t enough time to wait.”
Harriet Adamson: “So what are the options in such cases?”
Daniel Wendt: “In these situations, one possibility is a device called CytoSorb. It’s a special adsorber filled with a polymer and it is placed in the heart-lung machine during surgery to remove the DOAC medication from the blood while the surgery is happening. To study how well this works in the everyday world, the STAR (Safe and Timely Antithrombotic Removal) registry was started in September 2021. This is an international project involving several centers in Europe, and they are still collecting data from patients.”
Harriet Adamson: “Before telling me about this exciting 2nd publication, perhaps you could summerize the results from the first STAR Registry publication from 2024?”
Daniel Wendt: “Sure – the first study by Schmoeckel and colleagues looked at two groups of patients: 114 patients taking P2Y12 inhibitors and 51 patients taking DOACs. On average, these patients had surgery about 33.2 hours and 44.6 hours after their last dose of the medication. The results showed that the procedure is safe and that CytoSorb can effectively help manage bleeding risks during surgery.”(1)
Harriet Adamson: “Has this new publication confirmed these findings?”
Daniel Wendt: “Yes, and it has expanded them. In total, 62 patients from seven well-known hospitals in Austria, Germany, Sweden, and the UK underwent urgent coronary artery bypass surgery and/or single valve surgery. Surgery started a median of 28.9 hours after the last dose of a DOAC. Nearly half of the patients were on apixaban (48.4%), while the rest were on rivaroxaban (24.2%) or edoxaban (24.2%). And 21% of all patients were also taking aspirin.” (2) On average, the heart-lung machine was used for about 2 hours. Severe bleeding (classified as UDPB ≥ 3) happened in 4.8% of patients, and major bleeding (known as BARC-4) occurred in 3.2%. Only one patient (1.6%) needed a second surgery to control their bleeding. The average chest tube drainage in the first 24 hours was 771.3 (± 482.79) mL. And again, no complications related to the device were reported.
Harriet Adamson: “Any other take home messages from the study?”
Daniel Wendt: “This study highlights some key points. Surgery was performed about 28 hours after the last DOAC dose, even though current guidelines recommend waiting more than 48 hours, especially for patients with kidney or liver issues. Despite this shorter wait time, the rate of serious bleeding complications during surgery was much lower than what’s typically reported for similar cases (4.8% compared to 23%). In fact, the bleeding rates were similar to those of patients not taking DOACs. Additionally, only 1.6% of patients needed a second surgery to control bleeding, much lower than the 6.3–11.4% reported in other studies on DOAC patients. Red blood cell transfusion rates were also comparable to those of patients not on DOACs.”
Professor Daniel Wendt summarized: “The conclusions of this study are that hemoadsorption appears to be a feasible, safe and potentially effective solution for reducing perioperative bleeding in this patient population. Compared to the more expensive and potentially problematic pharmacological alternatives, I can only agree with this statement.”
Prof Dr Daniel Wendt on the results of the second interim STAR Registry analysis: “Hemoadsorption appears to be a feasible, safe and potentially effective solution for reducing perioperative bleeding in patients on oral anticoagulants”
Schmoeckel M et al. Intraoperative haemoadsorption for antithrombotic drug removal during cardiac surgery: initial report of the international safe and timely antithrombotic removal (STAR) registry.” J Thromb Thrombolysis 2024; 57(6):888-897
Schmoeckel M et al. Direct-acting oral anticoagulant removal by intraoperative hemoadsorption in CABG and/or single valve surgery: interim analysis of the International Safe and Timely Antithrombotic Removal (STAR) registry. J Cardiothorac Surg 2025; 20(1):74

About the Author
Prof Dr Wendt, a cardiac surgeon based in Essen, formerly served as the co-director of the Westgerman Heart and Vascular Center in Essen until 2021.
From January 1st 2022, he was appointed as Vice President (cardiovascular) of the company CytoSorbents. His medical expertise covers the whole field of adult cardiac surgery, and he is also specialized in intensive care medicine. Moreover, he is member of numerous medical societies, and he serves as Editorial Board member for many scientific journals. So far, he published more than 150 peer-reviewed articles.
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