Correlations of perioperative coagulopathy, fluid infusion and blood transfusions with survival prognosis in endovascular aortic repair for ruptured abdominal aortic aneurysm

Abstract

BackgroundFactors associated with survival prognosis among patients who undergo endovascular aortic repair (EVAR) for ruptured abdominal aortic aneurysms (rAAA) have not been sufficiently investigated. In the present study, we examined correlations between perioperative coagulopathy and 24-h and 30-day postoperative survival. Relationships between coagulopathy and the content of blood transfusions, volumes of crystalloid infusion and survival.MethodsThis was a retrospective study of the medical records of all patients who underwent EVAR for rAAA at Chiba-Nishi General Hospital during the period from October 2013 to December 2015. Major coagulopathy was defined using the international normalized ratio or activated partial thromboplastin time (APTT) ratio of at least 1.5, or platelet count less than 50 × 10/l. We quantified the amounts of blood transfusions and crystalloid infusions administered from arrival to the hospital to admission to ICU following operations.ResultsCoagulopathy among patients with rAAA was found to progress even after they had presented at the hospital. No statistically significant correlation between preoperative coagulopathy and mortality was found, although a significantly greater degree of postoperative coagulopathy was seen among patients who died both within 24-h and 30 days postoperatively. Among patients with postoperative coagulopathy, lesser quantities of fresh frozen plasma (FFP) compared with red cell concentrate (RCC) were used during the period from hospital arrival to postoperative ICU entry. In both groups of patients who did not survive after 24-h and 30 days, FFP was used less than RCC. Large transfusions of crystalloids administered during the periods from hospital arrival to surgery and from hospital arrival to the end of surgery were associated with postoperative incidence of major coagulopathy, death within 24-h, and death within 30 days.ConclusionCoagulopathy progressed during care in the emergency outpatient clinic and operations. Postoperative coagulopathy was associated with poorer outcomes. Smaller FFP/RCC ratios and larger volumes of crystalloid infusion were associated with development of coagulopathy and poorer prognosis of survival.Trial registrationThis study is retrospectively registered in UMIN Clinical Trials Registry (Registration 19 April 2016, registered number is R000025334 UMIN000021978).

The impact of perioperative factors on the outcome in patients with ruptured abdominal aortic aneurysm

“…U devetogodišnjoj studiji koju su sproveli Hili (Healey) i saradnici, smrtnost u prvih 30 dana od operacije iznosila je 33,4%, takođe za otvorenu aneurizmektomiju [14]. Za razliku od studija sprovedenih u zemljama Zapada, studija sličnog karaktera sprovedena u Beogradu (u kojoj su, kao i u našoj studiji, pacijenti bili operisani otvorenom hirurškom tehnikom) imala uticaj perioperativnih faktora na ishod kod pacijenata sa rupturiranom aneurizmom abdominalne aorte the impact of perioperative factors on the outcome in patients with ruptured abdominal aortic aneurysm same parameters on patients operated on endovascular methods, where these parameters were not proven to be statistically significant for the outcome [16].…”

“…Komponente hemostaznog sistema u preoperativnom periodu (APTT, PT) su se u našoj studiji pokazale kao statistički značajne za ishod. Kavatani (Kawatani) i saradnici u sklopu svoje studije proučavali su uticaj istih ovih parametara na pacijente operisane endovaskularnom metodom, gde se ovi parametri nisu dokazali kao statistički značajni za ishod [16].…”

The emergency medical team's role in initial treatment and transport of patients with abdominal aortic aneurysm rupture

“…Tako je postalo jasno da je permisivna hipotenzija od presudne važnosti u toku transporta i dijagnostike ovih pacijenata. Ovde se može iskoristiti iskustvo transporta bolesnika sa teškom traumom kod kojih je evidentirano veće preživljavanje ako je nadoknada tečnosti bila odložena do trenutka ulaska u operacionu salu [37]. Cilj kojem treba težiti je održavanje bolesnika svesnim, prevencija infarkta miokarda i sistolni pritisak u granicama od oko 80 mm Hg a nikako preko 100 mm Hg.…”