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Consumption coagulopathy in acute aortic dissection: principles of management
Yuyong Liu1, Lu Han1, Jiachen Li1
1Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Lab for Cardiovascular Precision Medicine, and Beijing Engineering Research Center of Vascular Prostheses, No. 2 Anzhen Street, Beijing, 100029, China.
Insights
Acute aortic dissection causes consumption coagulopathy, significantly reducing clotting factors and fibrinogen. Hemostatic therapy should prioritize rapid supplementation of these factors to manage this condition.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Coagulation Science
Background:
- Consumption coagulopathy in acute aortic dissection (AAD) and its surgical implications remain understudied.
- The impact of AAD itself on coagulopathy has not been specifically investigated.
Purpose of the Study:
- To perioperatively characterize consumption coagulopathy in patients undergoing treatment for AAD.
- To compare coagulopathy markers between AAD patients and a control group with thoracic aortic aneurysms.
Main Methods:
- Prospective enrollment of 66 patients with acute type A aortic dissection and 36 controls with thoracic aortic aneurysms.
- Evaluation of consumption coagulopathy using standard laboratory tests, ELISA, and thromboelastography at five perioperative time-points.
Main Results:
- AAD onset was associated with significant reductions in clotting factors and fibrinogen.
- Persistent systemic coagulation activation and clotting factor consumption were confirmed by ELISA and thromboelastography.
- Platelet counts were low in AAD patients, but platelet function was not significantly more impaired compared to controls.
Conclusions:
- Clotting factors and fibrinogen are more severely affected than platelet function post-surgery in AAD patients.
- Recommended hemostatic therapy involves rapid and adequate supplementation of clotting factors and fibrinogen to address consumption coagulopathy.
Background:
The effect of acute aortic dissection itself on coagulopathy or surgery-related coagulopathy has never been specifically studied. The aim of the present study was to perioperatively describe consumption coagulopathy in patients with acute aortic dissection.
Methods:
Sixty-six patients with acute type A aortic dissection were enrolled in this study from January 2015 to September 2016. Thirty-six patients with thoracic aortic aneurysms were used as a control group during the same period. Consumption coagulopathy was evaluated using standard laboratory tests, enzyme-linked immunosorbent assay and thromboelastograghy at five perioperative time-points.
Results:
A significant reduction in clotting factors and fibrinogen was observed at the onset of acute aortic dissection. Enzyme-linked immunosorbent assay and thromboelastograghy also revealed a persistent systemic activation of the coagulation system and the consumption of clotting factors. In contrast, although platelet counts were consistently low, we did not find that platelet function was more impaired in the acute aortic dissection group than the control group.
Conclusions:
After surgery, clotting factors and fibrinogen were more impaired than platelet function. Thus, we proposed that hemostatic therapy should focus on the rapid and sufficient supplementation of clotting factors and fibrinogen to improve consumption coagulopathy in patients with acute aortic dissection.
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