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The role of von Willebrand factor in acute type A aortic dissection and aortic surgery

Zindovic, Igor LU ; Sjögren, Johan LU ; Bjursten, Henrik LU ; Ingemansson, Richard LU ; Larsson, Mårten LU ; Svensson, Peter J. LU ; Strandberg, Karin LU ; Wierup, Per LU and Nozohoor, Shahab LU (2019) In Thrombosis Research 178. p.139-144
Abstract

Introduction: Massive bleeding is a serious complication associated with impaired survival after surgery for acute type A aortic dissection (ATAAD). There are no previous reports evaluating the effect of ATAAD and associated surgery on von Willebrand factor (VWF). The aim of the present study was to analyze VWF activity (VWF:GPIbM) and thus the potential of Factor (F) VIII/VWF concentrate as a treatment for refractory bleeding in surgery for acute type A aortic dissection. Material and methods: We prospectively compared serial measurements of VWF:GPIbM in 25 patients with ATAAD to 20 control patients undergoing elective surgery of the ascending aorta or the aortic root. In 10 of the ATAAD patients, high molecular weight multimer... (More)

Introduction: Massive bleeding is a serious complication associated with impaired survival after surgery for acute type A aortic dissection (ATAAD). There are no previous reports evaluating the effect of ATAAD and associated surgery on von Willebrand factor (VWF). The aim of the present study was to analyze VWF activity (VWF:GPIbM) and thus the potential of Factor (F) VIII/VWF concentrate as a treatment for refractory bleeding in surgery for acute type A aortic dissection. Material and methods: We prospectively compared serial measurements of VWF:GPIbM in 25 patients with ATAAD to 20 control patients undergoing elective surgery of the ascending aorta or the aortic root. In 10 of the ATAAD patients, high molecular weight multimer distribution was measured. Results: Preoperatively, ATAAD patients demonstrated significantly higher VWF:GPIbM (1.58 (1.40–2.05) kIU/L vs 1.25 (1.02–1.42) kIU/L, p = 0.003). In the ATAAD group, VWF:GPIbM significantly decreased to 1.24 (0.98–1.44) kIU/L at lowest core temperature (T0 vs T1 p < 0.001), but remained unchanged in the elective group (1.25 (1.04–1.43) kIU/L, T0 vs T1 p < 0.625). Neither aortic dissection nor hypothermia caused any changes to the proportion of high molecular weight multimers when compared to control patients. Both groups demonstrated supernormal VWF:GPIbM on the first and fifth day after surgery. Conclusions: This report showed that patients with acute aortic dissection had increased levels of VWF:GPIbM before surgery that decreased slightly during surgery. Our study could not provide evidence that would encourage administration of FVIII/VWF concentrate for major bleeding in patients undergoing surgery for ATAAD as well as elective aortic procedures.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Aorta, Cardiac surgical procedures, Dissection, Hemorrhage, von Willebrand factor
in
Thrombosis Research
volume
178
pages
6 pages
publisher
Elsevier
external identifiers
  • scopus:85064541092
  • pmid:31030033
ISSN
0049-3848
DOI
10.1016/j.thromres.2019.04.018
language
English
LU publication?
yes
id
3869741e-7935-4a70-b788-ce22f9697162
date added to LUP
2019-05-03 09:40:20
date last changed
2024-05-15 05:54:08
@article{3869741e-7935-4a70-b788-ce22f9697162,
  abstract     = {{<p>Introduction: Massive bleeding is a serious complication associated with impaired survival after surgery for acute type A aortic dissection (ATAAD). There are no previous reports evaluating the effect of ATAAD and associated surgery on von Willebrand factor (VWF). The aim of the present study was to analyze VWF activity (VWF:GPIbM) and thus the potential of Factor (F) VIII/VWF concentrate as a treatment for refractory bleeding in surgery for acute type A aortic dissection. Material and methods: We prospectively compared serial measurements of VWF:GPIbM in 25 patients with ATAAD to 20 control patients undergoing elective surgery of the ascending aorta or the aortic root. In 10 of the ATAAD patients, high molecular weight multimer distribution was measured. Results: Preoperatively, ATAAD patients demonstrated significantly higher VWF:GPIbM (1.58 (1.40–2.05) kIU/L vs 1.25 (1.02–1.42) kIU/L, p = 0.003). In the ATAAD group, VWF:GPIbM significantly decreased to 1.24 (0.98–1.44) kIU/L at lowest core temperature (T0 vs T1 p &lt; 0.001), but remained unchanged in the elective group (1.25 (1.04–1.43) kIU/L, T0 vs T1 p &lt; 0.625). Neither aortic dissection nor hypothermia caused any changes to the proportion of high molecular weight multimers when compared to control patients. Both groups demonstrated supernormal VWF:GPIbM on the first and fifth day after surgery. Conclusions: This report showed that patients with acute aortic dissection had increased levels of VWF:GPIbM before surgery that decreased slightly during surgery. Our study could not provide evidence that would encourage administration of FVIII/VWF concentrate for major bleeding in patients undergoing surgery for ATAAD as well as elective aortic procedures.</p>}},
  author       = {{Zindovic, Igor and Sjögren, Johan and Bjursten, Henrik and Ingemansson, Richard and Larsson, Mårten and Svensson, Peter J. and Strandberg, Karin and Wierup, Per and Nozohoor, Shahab}},
  issn         = {{0049-3848}},
  keywords     = {{Aorta; Cardiac surgical procedures; Dissection; Hemorrhage; von Willebrand factor}},
  language     = {{eng}},
  pages        = {{139--144}},
  publisher    = {{Elsevier}},
  series       = {{Thrombosis Research}},
  title        = {{The role of von Willebrand factor in acute type A aortic dissection and aortic surgery}},
  url          = {{http://dx.doi.org/10.1016/j.thromres.2019.04.018}},
  doi          = {{10.1016/j.thromres.2019.04.018}},
  volume       = {{178}},
  year         = {{2019}},
}