Initial emergency department coagulation profile does not predict survival in ruptured abdominal aortic aneurysm

The aim of this study was to describe baseline coagulation in patients presenting to the emergency department (ED) with a ruptured abdominal aortic aneurysm (rAAA) and its effect on survival.

Retrospective study of ED, theatre and laboratory records of patients presenting with rAAA to the Royal Infirmary of Edinburgh ED. Patients with symptomatic aneurysms, those without an initial ED coagulation screen and those on warfarin were excluded. Major coagulopathy was defined as international normalized ratio or activated partial thromboplastin time (APTT) ratio of at least 1.5 or platelet count less than 50 × 10/l.

Between 1 July 2006 and 31 March 2011, 119 patients were enrolled. Mean (± SD) age was 76.5 ± 7.6 years and male to female ratio was 2.3 : 1. Ten patients died in the ED, 20 were considered not fit for surgery and 89 went to theatre. A total of 56 survived to hospital discharge. Seventeen (14.3%) patients had a major coagulopathy; an international normalized ratio or APTT ratio of at least 1.5. No patients had platelets less than 50 × 10/l, but eight patients had platelets less than 100 × 10/l. Neither ED prothrombin time (PT) nor ED APTT was associated with survival in either the operated [P=0.167 NS (PT) and P=0.353 NS (APTT); two-sided t-test] or entire cohort [P=0.254 NS (PT) and P=0.413 NS (APTT); two-sided t-test] groups.

Although coagulopathy is often present in patients presenting with a rAAA, it does not seem to be associated with a poorer outcome. Our results seem to suggest that altering the current practice of minimal transfusion in the ED to include early transfusion of blood products, such as platelets or fresh frozen plasma, is therefore unlikely to improve outcome.