## 4 Discussion
### Advantages and Disadvantages  
The integration of CytoSorb(r) hemoadsorption technology into clinical practice presents various advantages and disadvantages that need careful consideration to maximize its effectiveness. A key benefit is the notable decrease in the risk of perioperative bleeding. By effectively removing anticoagulants like ticagrelor and rivaroxaban from the bloodstream within a controlled time frame, CytoSorb(r) helps reduce the risk of excessive bleeding during and after surgery. This is especially important for patients undergoing major orthopedic or trauma-related procedures. The ability to minimize bleeding is particularly valuable in situations where delays in surgical intervention could lead to serious complications. Expedited surgeries are crucial as they help lower the risks associated with prolonged immobilization, such as thromboembolism, infection, or the delayed healing of fractures [1; 2; 3; 4]. One key advantage of CytoSorb(r) is its potential to reduce the duration of hospital stays. By allowing faster and safer surgical interventions, CytoSorb(r) may help decrease both preoperative waiting times and postoperative recovery periods. This can lead to cost savings for healthcare systems and improve patient flow in emergency departments and surgical units. Moreover, CytoSorb(r)s ability to quickly clear anticoagulants enhances the use of regional anesthesia, which is often preferred for many orthopedic procedures because it poses a lower risk of systemic complications compared to general anesthesia. Regional anesthesia is associated with reduced rates of postoperative delirium, faster recovery of cognitive function, and fewer respiratory complications. Therefore, having access to CytoSorb(r) could enable safer administration of neuraxial and peripheral nerve blocks in patients on anticoagulants, or in therapy with ticagrelor in line with the current guidelines from the good clinical practice recommended by the ESRA [9].  
Despite its benefits, there are significant challenges associated with the implementation of CytoSorb(r). One primary drawback is the need for specialized personnel to carry out hemofiltration sessions. This requires trained operators who can manage the extracorporeal circuits and monitor the patient's hemodynamics throughout the procedure. Additionally, coordinating operating room schedules to accommodate hemoadsorption sessions adds another layer of complexity, especially in busy hospitals or during times of high patient influx. These logistical issues may limit their application in certain settings. CytoSorb(r) offers several advantages over conventional pharmacological reversal agents, such as anddexanet alfa and idarucizumab, particularly in emergency settings where immediate availability is critical. Unlike specific reversal agents that target only a single anticoagulant pathway, CytoSorb(r) provides broad-spectrum adsorption capability, making it a versatile tool for patients on multiple antithrombotic medications. Nonetheless, before widespread adoption, careful consideration of economic factors and logistical integration into routine clinical workflows is essential. Cost-benefit analyses and resource allocation strategies should be developed to optimize the clinical utility of this technology. Furthermore, rigorous multicenter, randomized controlled trials are warranted to validate these preliminary findings, define standardized treatment protocols, and ensure reproducibility across diverse healthcare environments. Additional research should also explore patient-centered outcomes such as quality of life, the length of hospital stay, and long-term survival.