Prevalence, indications and appropriateness of antiplatelet therapy in patients operated for acute aortic dissection: associations with bleeding complications and mortality

Abstract

The indication for immediate antiplatelet therapy in patients later operated for acute aortic dissection was weak or absent in the majority of cases. Patients with ongoing platelet inhibition had more bleeding complications. Dual antiplatelet therapy was associated with increased early mortality.

Recombinant factor VIIa use in acute type A aortic dissection repair: A multicenter propensity-score-matched report from the Nordic Consortium for Acute Type A Aortic Dissection

“…[5][6][7] Consequently, massive intraoperative and postoperative bleeding is a feared complication associated with considerably elevated morbidity and mortality. 8,9 Since first described in 2001, 10 recombinant factor VIIa (rFVIIa) (Novoseven; Novo Nordisk A/S, Bagsvaerd, Denmark) has gained increasing use for treating refractory bleeding in the off-label setting of cardiothoracic surgery. Previous studies have reported that rFVIIa effectively reduces blood loss and the need for allogeneic blood transfusions in standard cardiac surgery 11,12 ; however, questions have been raised as to whether the prothrombotic properties of rFVIIa lead to an increased risk of thromboembolic complications when used in patients without hemophilia.…”

How to manage prasugrel and ticagrelor in daily practice

“…Pre-operative aspirin intake has been associated with increased blood loss, especially with aspirin doses N 325 mg/day [59], although generally without any clinical significance [60]. Several studies showed that clopidogrel, when associated with aspirin, increases bleeding and transfusion requirements in patients undergoing CABG [61] or other invasive surgery [62,63]. Recent studies have tended to show that the more potent the platelet inhibition provided by P2Y12 inhibitors, the higher the risk of bleeding [22,23].…”

Ticagrelor-Associated Bleeding in a Patient Undergoing Surgery for Acute Type A Aortic Dissection

“…2 Dual antiplatelet therapy with aspirin and clopidogrel increases perioperative bleeding and mortality in this patient group. 2 The significance of treatment with the novel antiplatelet drugs in this context has not been reported.…”

“…However, the use of prasugrel is associated with greater postoperative bleeding than clopidogrel. 2,3 Whether or not prasugrel therapy increases the incidence of postoperative bleeding complications is unknown. There are few reports on the management of major bleeding in patients on prasugrel prior to surgery, and the reversal of prasugrelinduced platelet inhibition with platelet transfusion has not been reported.…”