The Coagulopathy of Acute Type A Aortic Dissection: A Prospective, Observational Study.

Abstract

OBJECTIVE:

To evaluate the hemostatic system in patients undergoing surgery for acute type A aortic dissection (ATAAD) compared with those undergoing elective aortic procedures.

DESIGN:

This was a prospective, observational study.

SETTING:

The study was performed at a single university hospital.

PARTICIPANTS:

Twenty-five patients with ATAAD were compared with 20 control patients undergoing elective surgery of the ascending aorta or the aortic root.

INTERVENTIONS:

No interventions were performed.

MEASUREMENTS AND MAIN RESULTS:

Platelet count and levels of fibrinogen, D-dimer, prothrombin time/international normalized ratio, activated partial thromboplastin time, and antithrombin were analyzed perioperatively and compared between the 2 groups. Patients with ATAAD had lower preoperative levels of platelets (188 [156-217] × 109/L v 221 [196-240] × 109/L; p = 0.018), fibrinogen (1.9 [1.6-2.4] g/L v 2.8 [2.2-3.0] g/L; p = 0.003), and antithrombin (0.81 [0.73-0.94] kIU/L v 0.96 [0.92-1.00] kIU/L; p = 0.003) and significantly higher levels of D-dimer (2.9 [1.7-9.7] mg/L v 0.1 [0.1-0.2] mg/L; p < 0.001) and prothrombin time/international normalized ratio (1.15 [1.1-1.2] v 1.0 [0.93-1.0]; p = 0.001). Surgery caused significant changes of the coagulation system in both groups. Intraoperative bleeding volumes were larger in the ATAAD group (2,407 [1,804-3,209] mL v 1,212 [917-1,920] mL; p < 0.001), and patients undergoing ATAAD surgery received significantly more transfusions of red blood cells (2.5 [0.25-4.75] U v 0 [0-2.75] U; p = 0.022), platelets (4 [3.25-6] U v 2 [2-4] U; p = 0.002), and plasma (2 [0-4] U v 0 [0-0] U; p = 0.004) compared with the elective group.

CONCLUSIONS:

This study demonstrates that ATAAD is associated with a coagulopathic state. Surgery causes additional damage to the hemostatic system in ATAAD patients, but also in patients undergoing elective surgery of the ascending aorta or the aortic root.

• Authors: Igor Zindovic, Johan Sjögren, Henrik Bjursten, Richard Ingemansson, Jonas Ingimarsson, Mårten Larsson, Peter J Svensson, Karin Strandberg, Per Wierup, Shahab Nozohoor
• Journal: Journal of cardiothoracic and vascular anesthesia (J Cardiothorac Vasc Anesth) Vol. 33 Issue 10 Pg. 2746-2754 (Oct 2019) ISSN: 1532-8422 [Electronic] United States
• PMID: 30876766 (Publication Type: Journal Article, Observational Study)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Chemical References

• Fibrin Fibrinogen Degradation Products
• fibrin fragment D
• Fibrinogen

Topics

• Acute Disease
• Aged
• Aortic Dissection (blood, surgery)
• Aorta (surgery)
• Aortic Aneurysm, Thoracic (blood, surgery)
• Blood Coagulation Disorders (blood, etiology)
• Blood Coagulation Tests (methods)
• Blood Loss, Surgical
• Blood Transfusion (methods, statistics & numerical data)
• Case-Control Studies
• Female
• Fibrin Fibrinogen Degradation Products (metabolism)
• Fibrinogen (metabolism)
• Humans
• Male
• Middle Aged
• Platelet Count
• Postoperative Complications (blood, etiology)
• Prospective Studies
• Vascular Grafting (adverse effects, methods)