• Igor Zindovic, Johan Sjögren, Henrik Bjursten, Richard Ingemansson, Jonas Ingimarsson, Mårten Larsson, Peter J Svensson, Karin Strandberg, Per Wierup, and Shahab Nozohoor.
• Lund University, Skåne University Hospital, Department of Clinical Sciences, Lund, Department of Cardiothoracic Surgery, Lund, Sweden. Electronic address: igor.zindovic@med.lu.se.
• J. Cardiothorac. Vasc. Anesth. 2019 Oct 1; 33 (10): 2746-2754.

ObjectiveTo evaluate the hemostatic system in patients undergoing surgery for acute type A aortic dissection (ATAAD) compared with those undergoing elective aortic procedures.DesignThis was a prospective, observational study.SettingThe study was performed at a single university hospital.ParticipantsTwenty-five patients with ATAAD were compared with 20 control patients undergoing elective surgery of the ascending aorta or the aortic root.InterventionsNo interventions were performed.Measurements And Main ResultsPlatelet 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.ConclusionsThis 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.Copyright © 2019 Elsevier Inc. All rights reserved.

42 keywords...

hide…