Outcomes of Preoperative Antiplatelet Therapy in Patients with Acute Type A Aortic Dissection

Abstract

Background: Acute type A aortic dissection(ATAAD) is life-threatening and requires immediate surgery. Sudden chest pain may lead to a risk of misdiagnosis as acute coronary syndrome and may lead to subsequent antiplatelet therapy. We used the Chinese Acute Aortic Syndrome Collaboration Database (AAS) to study the effects of antiplatelet therapy (APT) on clinical outcomes. Methods: The AAS database is a retrospective multicentre database where 31 of 3092 had APT with aspirin or clopidogrel or both before surgery. Before and after propensity score matching, the incidence of complications and mortality was compared between APT and non-APT patients by using a logistic regression model. The sample remaining after PSM was 30 in the APT group and 80 in the non-APT group. Results: The sample remaining after matching was 30 in the APT group and 80 in the non-APT group. We found 10 cases with percutaneous coronary intervention in the APT group(33.3%). The APT group received more volume of packed red blood cell (RBC), 8.4±6.05 units; plasma, 401.67±727 ml, and platelet transfusion(14.07±8.92 units). The drainage volume was much more in the APT group( 5009.37±2131.44ml, P=0.004). Mortality was higher in APT group(26% vs 10%, P=0.027). The preoperative APT was independent predictor of mortality(OR 6.808, 95% CI1.554-29.828, P = 0.011). Conclusion: APT prior to ATAAD repair was associated with more transfusions and higher early mortality. The timing of surgery should be carefully considered based on the patient’s status and the surgeon’s experience.

Impact of unintentional coronary angiography on outcomes of emergency surgery in acute type A aortic dissection: a retrospective study

“…Patients with ATAAD were occasionally misdiagnosed as ACS and transferred to a catheterization laboratory to undergo coronary angiography (CA) without knowledge of the ATAAD (unintentional CA) [6][7][8]. Unintentional coronary angiography might result in signi cant surgical delay, not only due to time consumption in search of coronary ostia in the diseased aortic root, but also the administration of overload dose of dual antiplatelet agents, inevitably resulting in coagulopathy and signi cant risk of perioperative bleeding, which makes the decision of emergency surgery very di cult [9][10][11]. Previous studies had shown that emergency operation was postponed or even concealed in ATAAD patients who undergoing preoperative CA [12,13] which undoubtedly increased the risk of death.…”

Impact of unintentional coronary angiography on outcomes of emergency surgery in acute type A aortic dissection: a retrospective study

“…Unintentional CA might result in significant surgical delay, due to the time spent searching of coronary ostia in the diseased aortic root. In addition, the dual antiplatelet administration in preparation for potential coronary intervention significantly increased the risk of coagulopathy and perioperative bleeding, making the decision to operate urgently difficult [9][10][11]. Previous studies had shown that emergency operation was postponed or even concealed in ATAAD patients who undergoing preoperative CA [12,13], which undoubtedly increased the risk of death.…”

Letter To the Editor: Outcomes of Preoperative Antiplatelet Therapy in Patients With Acute Type A Aortic Dissection

“…Funding : None Dear Editor, We have, in recent times, read with great interest the article entitled " Outcomes of Preoperative Antiplatelet Therapy in Patients With Acute Type A Aortic Dissection" by Xuan Jiang MD et al 1 We highly appreciate the author's efforts towards this highly sensitive topic and it needs to be applauded by the readers.…”