Preoperative dual antiplatelet therapy increases bleeding and transfusions but not mortality in acute aortic dissection type A repair

Hansson, Emma C.; Geirsson, Arnar; Hjortdal, Vibeke E.; Mennander, Ari; Olsson, Christian; Gunn, Jarmo; Zindovic, Igor; Ahlsson, Anders; Nozohoor, Shahab; Chemtob, Raphaelle A.; Pivodic, Aldina; Guðbjartsson, Tómas; Jeppsson, Anders

doi:10.1093/ejcts/ezy469

Cited by 24 publications

(26 citation statements)

References 18 publications

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“…The disturbances of the coagulation system in combination with the poor quality of the dissected aorta contribute to 25% of patients having massive bleeding associated with ATAAD surgery [10,87]. In several studies, bleeding has been identified as an independent predictor of early and late mortality after surgery for ATAAD and accounts for 20% of in-hospital deaths [6,10,88]. The bleeding can also extend into the pericardium and cause tamponade that can aggrevate cardiac and hypovolemic shock (Figure 3(c)).…”

Section: Complicationsmentioning

confidence: 99%

“…Thus, contemporary, sizeable, multicenter observational registries, of which NORCAAD is an example, stand out as important sources of information. This review covers different aspects of ATAAD, including epidemiology, pathophysiology, and surgical treatment, and concentrates especially on the NORCAAD studies that have been published so far [6][7][8][9][10][11][12][13]. We searched the PubMed and MEDLINE databases using the search terms "dissection," "aortic," "ascending," and "type A."…”

Section: Introductionmentioning

confidence: 99%

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Acute type A aortic dissection – a review

Guðbjartsson

Ahlsson

Geirsson

et al. 2019

Scandinavian Cardiovascular Journal

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105

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Acute type A aortic dissection (ATAAD) is still one of the most challenging diseases that cardiac surgeons encounter. This review is based on the current literature and includes the results from the Nordic Consortium for Acute Type-A Aortic Dissection (NORCAAD) database. It covers different aspects of ATAAD and concentrates on the outcome of surgical repair. The diagnosis is occasionally delayed, and ATAAD is usually lethal if prompt repair is not performed. The dynamic nature of the disease, the variation in presentation and clinical course, and the urgency of treatment require significant attentiveness. Many surgical techniques and perfusion strategies of varying complexity have been described, ranging from simple interposition graft to total arch replacement with frozen elephant trunk and valve-sparing root reconstruction. Although more complex techniques may provide long-term benefit in selected patients, they require significant surgical expertise and experience. Short-term survival is first priority so an expedited operation that fits in with the surgeon's level of expertise is in most cases appropriate. ARTICLE HISTORY Definitions and classification systemsDissection of the aorta occurs when the aortic media is separated, usually by pulsatile flow that penetrates the intimal layer of the aortic wall [14] (Figure 1(b)). This allows blood to flow between the layers of the aortic wall, forcing the layers apart, creating a false lumen parallel to the native (i.e. true) aortic lumen (Figure 1(b)). Consequently, the false lumen can propagate in both directions from the tear of intima and affect most of its distal branches, including the coronary, cerebral, and mesenteric arteries [15]. Another-but less common-CONTACT Tomas Gudbjartsson

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Section: Complicationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Acute type A aortic dissection – a review

Guðbjartsson

Ahlsson

Geirsson

et al. 2019

Scandinavian Cardiovascular Journal

Self Cite

105

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“…Studies have shown that the use of DAPT prior to acute type A aortic dissection repair was associated with a higher risk of bleeding and transfusions, but not associated with mortality. However, major bleeding was higher in patients who received DAPT and major bleeding per se was associated with higher mortality [7].…”

Section: Discussionmentioning

confidence: 90%

Transverse Pericardial Sinus Hematoma From Type A Aortic Dissection: A Diagnostic Challenge

Qarajeh

Lehenbauer

Elkaryoni

et al. 2020

Cureus

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Ascending (type A) aortic dissection can rarely result in contained transverse pericardial sinus hematoma that compresses adjacent structures making diagnosis more challenging. We present a rare case of a 77-year-old man who presented with sudden-onset chest pain and was admitted for a presumed acute coronary syndrome. Coronary angiography did not show significant stenosis and ruled out acute coronary syndrome. Transthoracic echocardiogram showed extracardiac structure compressing on the left atrium; hence, we performed transesophageal echocardiogram which confirmed aortic dissection and revealed a hematoma in the transverse pericardial sinus. Intraoperatively, a large hematoma in the transverse pericardial sinus was extracted and revealed a posterior perforation of the ascending aorta that extended into the left atrium.

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“…18,10 There is strong evidence that ongoing dual antiplatelet therapy at the time of emergency cardiac surgery is associated with a greater incidence of major bleeding, larger transfusion requirement, 19 and greater odds of postoperative stroke and acute kidney injury. 20 Indeed, ticagrelor administered before repair of acute aortic dissection resulted in a larger volume of intraoperative blood loss and greater mortality over clopidogrel (38% v 18%; p = 0.19), although this difference was not significant owing to limited sample size. 21 Furthermore, a higher rate of bleeding was apparent within 72 hours of ticagrelor administration in cardiac surgery patients, highlighting the importance of the elapsed time from the last dose.…”

Section: Discussionmentioning

confidence: 95%