The Coagulopathy of Acute Type A Aortic Dissection : A Prospective, Observational Study
(2019) In Journal of Cardiothoracic and Vascular Anesthesia 33(10). p.2746-2754- 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... (More)
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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] × 10
9
/L v 221 [196-240] × 10
9
/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.
- author
- Zindovic, Igor LU ; Sjögren, Johan LU ; Bjursten, Henrik LU ; Ingemansson, Richard LU ; Ingimarsson, Jonas LU ; Larsson, Mårten LU ; Svensson, Peter J. LU ; Strandberg, Karin LU ; Wierup, Per LU and Nozohoor, Shahab LU
- organization
- publishing date
- 2019-02-11
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- aneurysm, aorta, bleeding, dissection
- in
- Journal of Cardiothoracic and Vascular Anesthesia
- volume
- 33
- issue
- 10
- pages
- 2746 - 2754
- publisher
- Elsevier
- external identifiers
-
- pmid:30876766
- scopus:85062602313
- ISSN
- 1053-0770
- DOI
- 10.1053/j.jvca.2019.02.013
- language
- English
- LU publication?
- yes
- id
- ebcf80a0-ff3c-4328-beaa-7044ee3840d8
- date added to LUP
- 2019-03-21 08:13:03
- date last changed
- 2024-09-17 16:12:39
@article{ebcf80a0-ff3c-4328-beaa-7044ee3840d8, abstract = {{<p><br> 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] × 10 <br> <sup>9</sup><br> /L v 221 [196-240] × 10 <br> <sup>9</sup><br> /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. <br> </p>}}, author = {{Zindovic, Igor and Sjögren, Johan and Bjursten, Henrik and Ingemansson, Richard and Ingimarsson, Jonas and Larsson, Mårten and Svensson, Peter J. and Strandberg, Karin and Wierup, Per and Nozohoor, Shahab}}, issn = {{1053-0770}}, keywords = {{aneurysm; aorta; bleeding; dissection}}, language = {{eng}}, month = {{02}}, number = {{10}}, pages = {{2746--2754}}, publisher = {{Elsevier}}, series = {{Journal of Cardiothoracic and Vascular Anesthesia}}, title = {{The Coagulopathy of Acute Type A Aortic Dissection : A Prospective, Observational Study}}, url = {{http://dx.doi.org/10.1053/j.jvca.2019.02.013}}, doi = {{10.1053/j.jvca.2019.02.013}}, volume = {{33}}, year = {{2019}}, }