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ORal anticoagulation risks late aortic intervention in Conservatively managed type B Aortic dissection (ORCA study)
Katarzyna Jesse1,2, Lorenz Meuli1, Reinhard Kopp1
1Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland.
Insights
Oral anticoagulation (OAC) therapy in patients with acute type B aortic dissection was linked to a higher risk of late aortic interventions. Patients on OAC require close monitoring for aortic events.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Medical Research
Background:
- Acute type B aortic dissection (TBAD) is a serious condition requiring careful management.
- The role of oral anticoagulation (OAC) in TBAD patients managed conservatively is not well-defined.
- Understanding OAC's impact is crucial for optimizing long-term patient outcomes.
Purpose of the Study:
- To evaluate the long-term effects of oral anticoagulation (OAC) on outcomes in patients with acute type B aortic dissection (TBAD).
- To determine if OAC influences the risk of late aortic events in conservatively managed TBAD patients.
Main Methods:
- Retrospective cohort study analyzing data from 69 patients with conservatively managed TBAD.
- Patients receiving OAC were compared to those not on OAC regarding late aortic events.
- Multivariable Cox proportional hazard models were used to analyze time-to-event data, adjusting for confounders.
Main Results:
- A total of 69 patients were included, with 68% receiving OAC during follow-up.
- 41% of patients experienced late aortic events, primarily interventions (39%).
- OAC was associated with a significantly increased risk of late aortic events (HR 3.94, P=0.040).
Conclusions:
- Oral anticoagulation therapy is associated with an increased risk of late aortic interventions in patients with type B aortic dissection.
- OAC should not be initiated solely for TBAD.
- Patients with TBAD on OAC for other indications necessitate vigilant follow-up imaging.
Objectives:
Single-center retrospective cohort study to evaluate the impact of oral anticoagulation (OAC) on long-term outcomes of conservatively managed acute type B aortic dissection.
Methods:
Clinical and morphological data of eligible patients from a high-volume vascular centre from 1 January 2003 through 31 December 2020 were evaluated. Patients were excluded for: type A or non-A-non-B dissection, isolated abdominal dissection, intramural haematoma and connective tissue disease. The primary outcome was freedom from late aortic events (intervention, rupture and mortality). Secondary outcomes included spinal cord ischaemia, bleeding, reno-visceral artery occlusion, ilio-femoral intervention, dissection propagation, aortic growth, aortic remodelling, deterioration of false lumen thrombosis as well as 30-day and overall mortality. Time to event was analysed using multivariable Cox proportional hazard models with OAC as time-varying covariate and mortality as a competing risk. The impact of OAC was adjusted for potential confounding factors.
Results:
A total of 69 patients [50 males, median age 65 (interquartile range: 58-72) years] were enrolled. The median follow-up was 49.3 (28-92) months. A total of 47 patients (68%) received OAC at any time throughout the follow-up for a median length of 26 (11-61) months. Late aortic events occurred in 28 patients (41%) including intervention (n = 27, 39%) and rupture (n = 1, 1%). OAC was associated with more late aortic events (hazard ratio 3.94, 95% confidence interval 1.06-14.6, P = 0.040). Secondary outcomes were not associated with OAC.
Conclusions:
Our data suggest a relation of OAC therapy with an increased risk for late aortic interventions. Type B aortic dissection should not be the primary indication for OAC and patients with OAC for other indications require frequent follow-up imaging.
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