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Complete and Partial Aortic Occlusion for the Treatment of Hemorrhagic Shock in Swine
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Hemostasis alterations in patients with acute aortic dissection.

Domenico Paparella1, Crescenzia Rotunno, Pietro Guida

  • 1Division of Cardiac Surgery, Department of Emergency and Organ Transplant, University of Bari, Bari, Italy. dpaparella@cardiochir.uniba.it

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|March 15, 2011
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Summary

Blood flow in acute aortic dissection (AAD) activates coagulation, fibrinolysis, and platelets even before surgery. This pre-operative activation of the hemostatic system may impact patient outcomes.

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Area of Science:

  • Cardiovascular Surgery
  • Hematology
  • Critical Care Medicine

Background:

  • Acute aortic dissection (AAD) surgery often leads to significant bleeding and transfusion needs.
  • The role of blood flow in the false lumen of AAD in activating the hemostatic system is not fully understood.
  • Coagulopathy in AAD patients requires further investigation into its underlying pathophysiology.

Purpose of the Study:

  • To investigate the activation of coagulation, fibrinolysis, and platelets in patients undergoing surgery for AAD.
  • To evaluate the hemostatic system's response to blood flow within the false lumen of AAD.
  • To determine the timing and extent of hemostatic system activation in relation to AAD surgery.

Main Methods:

  • Studied 18 patients undergoing emergent surgery for Stanford type A AAD.
  • Assessed coagulation and fibrinolysis activation using prothrombin fragment 1.2 (F1.2) and plasmin-antiplasmin complex.
  • Measured platelet activation via platelet factor 4 at six time points: pre-, intra-, and post-operation.

Main Results:

  • All measured biomarkers (F1.2, plasmin-antiplasmin, platelet factor 4) showed increased levels pre-, during, and post-surgery.
  • Significant activation of coagulation, fibrinolysis, and platelets was observed even before surgery (T0) and early during cardiopulmonary bypass (T1).
  • Shorter time from symptom onset to intervention correlated with higher preoperative F1.2 and plasmin-antiplasmin levels.

Conclusions:

  • Blood flow through the false lumen in AAD potently activates the hemostatic system, commencing even before surgical intervention.
  • This pre-operative systemic activation of coagulation, fibrinolysis, and platelets is a significant finding.
  • The observed hemostatic system activation may influence the postoperative outcomes for patients with AAD.