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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.

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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
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
2024-04-16 02:23:46
@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}},
  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}},
}