Advanced

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

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 (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)


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.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; ; ; and
organization
publishing date
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
W B Saunders
external identifiers
  • scopus:85062602313
  • pmid:30876766
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
2020-10-07 06:22:16
@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 &lt; 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 &lt; 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},
  language     = {eng},
  month        = {02},
  number       = {10},
  pages        = {2746--2754},
  publisher    = {W B Saunders},
  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},
}