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Preoperative Coagulation Indicators Predict Prolonged Mechanical Ventilation in Acute Type a Aortic Dissection.

Runqiao Li1, Peiyuan Yao1, Jianji Wang1

  • 1Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

Annals of Vascular Surgery
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Preoperative coagulopathy in acute type A aortic dissection (ATAAD) patients is linked to prolonged mechanical ventilation (PMV). Assessing coagulation status pre-surgery can improve risk stratification for better patient outcomes.

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Area of Science:

  • Cardiovascular Surgery
  • Hematology
  • Critical Care Medicine

Background:

  • Preoperative coagulation dysfunction is common in acute type A aortic dissection (ATAAD).
  • Limited evidence exists on the association between preoperative coagulopathy and prolonged mechanical ventilation (PMV) after emergency ATAAD surgery.

Purpose of the Study:

  • To investigate the relationship between preoperative coagulation status and the incidence of PMV in patients undergoing emergency surgery for ATAAD.

Main Methods:

  • Retrospective analysis of clinical data from 793 ATAAD patients.
  • Stratification based on preoperative coagulation function indicators.
  • Logistic regression and nomogram analyses to assess coagulopathy and PMV association.

Main Results:

  • Patients with coagulation dysfunction had longer awakening times and higher incidence of PMV, postoperative acute kidney injury, and need for continuous renal replacement therapy.
  • Multivariable analysis identified age, surgery duration, cardiopulmonary bypass duration, lactic acid, creatinine, and fibrin degradation products (FDP) as significant factors for PMV.
  • Elevated preoperative FDP levels (>15.27 μg/mL) correlated with poorer early postoperative outcomes.

Conclusions:

  • Preoperative coagulopathy is significantly associated with PMV in ATAAD patients.
  • Coagulation status is clinically relevant for preoperative risk stratification in ATAAD.