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An increased prothrombin time-international normalized ratio in patients with acute type A aortic dissection:

Tomonari Fujimori1, Naoyuki Kimura2, Makiko Mieno3

  • 1Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanumacho, Omiya-ku, Saitama, 330-8503, Japan.

Surgery Today
|November 1, 2021
PubMed

Insights

Coagulopathy in acute type A aortic dissection (ATAAD) is linked to worse outcomes. Shock, a partially thrombosed false lumen, and mesenteric malperfusion predict this coagulopathy, impacting survival.

Area of Science:

  • Cardiovascular Surgery
  • Hematology
  • Vascular Medicine

Background:

  • Acute type A aortic dissection (ATAAD) is a life-threatening condition.
  • Coagulopathy is a frequent complication in ATAAD patients, but its predictors and impact on outcomes require further elucidation.

Purpose of the Study:

  • To investigate factors associated with coagulopathy in ATAAD patients.
  • To determine the influence of coagulopathy on patient outcomes following ATAAD repair.

Main Methods:

  • Retrospective analysis of 420 patients undergoing ATAAD repair.
  • Patients were categorized by admission prothrombin time-international normalized ratio (PT-INR): no coagulopathy (<1.2), mild (1.2-1.49), and severe (≥1.5).
  • Comparison of clinical presentation, dissection morphology, and outcomes across PT-INR groups; multivariable analysis to identify predictive factors.

Main Results:

  • Coagulopathy was associated with increased transfusion volume, longer operation times, higher in-hospital mortality (up to 37.5%), and poorer 5-year survival (down to 61.1%).
  • Patients in shock (especially with CPR) exhibited higher median PT-INR values.
  • Multivariable analysis identified shock, partially thrombosed false lumen, and mesenteric malperfusion as significant predictors of coagulopathy.

Conclusions:

  • Coagulopathy in ATAAD is associated with significantly worse clinical outcomes.
  • Shock, partially thrombosed false lumen, and mesenteric malperfusion are key predictors of dissection-related coagulopathy.
  • These findings highlight the importance of recognizing and managing coagulopathy in ATAAD.
Abstract

Keywords:
Aortic dissectionCoagulopathyPT-INR

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