Abstract / Summary
Abstract Background Acute type A aortic dissection is a highly emergent condition with a high mortality rate. The condition poses an imminent risk of serious complications such as coagulopathy with massive bleeding. This increases the risk of mortality even after surgical repair. Procoagulant drugs are routinely administered but some patients still suffer postoperative massive bleeding that can be fatal. The study aimed to investigate whether massive bleeding after surgical treatment for type A aortic dissection can be predicted preoperatively through routine coagulation tests such as APTT, PT (INR), fibrinogen, D-dimer, and platelets. Methods The study was a retrospective, single-center, cohort study performed at a tertiary cardiac surgery unit. A total of 474 patients who underwent surgery for type A aortic dissection at our department between January 2005 and May 2023 were included in the study. Of these, 87 patients had massive postoperative bleeding after surgery for type A aortic dissection and were compared to 387 patients who did not have massive postoperative bleeding. Uni- and multivariable analyses were performed using logistic regression. The multivariable model included predictors of massive bleeding. Bleeding-related routine lab variables were then forced into the model. Results Patients with massive bleeding (18%) had higher preoperative activated partial thromboplastin time (APTT) (33 s vs 29 s, p <0.01), and creatinine (97 µmol/L vs 87 µmol/L, p <0.01), as well as lower preoperative platelet counts (172 × 10 9 /L vs 187 × 10 9 /L, p =0.03) compared to patients without massive bleeding. Patients with massive bleeding also had longer duration of cardiopulmonary bypass (CPB) (221 min vs 170 min, p <0.01) and suffered more postoperative complications. Multivariable logistic regression identified preoperative APTT per mmol increment (OR 1.04 (95% CI 1.01–1.07, p =0.01), preoperative APTT > 34.5 s (OR 2.95 (95% CI 1.60–5.47), p <0.01), preoperative creatinine > 82.5 µmol/L (OR 2.16 (95% CI 1.15–4.06), p =0.02), hypertension (OR 1.83 (95% CI 1.01–3.32), p <0.05) and CPB time per 10 min increment (OR 1.09 (95% CI 1.05–1.13, p <0.01)) as independent predictors of massive bleeding. Conclusion Preoperative APTT exceeding 34.5 s was independently associated with massive bleeding after type A aortic dissection repair and may, pending prospective validation, help identify patients who could potentially benefit from earlier hemostatic intervention.