Outcome After Surgery for Acute Aortic Dissection: Influence of Preoperative Antiplatelet Therapy on Prognosis

Raphaelle Avigael Chemtob; Hasse Møller-Sørensen; Lene Holmvang; Peter Skov Olsen; Hanne Berg Ravn

doi:10.1053/j.jvca.2016.10.007

Outcome After Surgery for Acute Aortic Dissection: Influence of Preoperative Antiplatelet Therapy on Prognosis

Raphaelle Avigael Chemtob^*, Hasse Møller-Sørensen, Lene Holmvang, Peter Skov Olsen, Hanne Berg Ravn

^*Corresponding author for this work

Department of Clinical Medicine

6 Citations (Scopus)

Abstract

Objectives Outcome in patients with acute coronary syndrome (ACS) is improved with dual antiplatelet therapy (DAPT). Patients with acute aortic dissection type A (AAD) often present with similar symptoms and may therefore be prescribed DAPT before diagnosis. The aim of this study was to evaluate the use of antiplatelet therapy (APT) prior to AAD surgery and patient outcome, including indications according to the European Society of Cardiology's (ESC) recent guidelines. Design A retrospective, observational study. Setting A tertiary University Hospital, Rigshospitalet, Heart Centre, Copenhagen, Denmark. Participants The study included 171 patients operated for AAD during 2010 to 2014. Interventions The independent relationship of preoperative APT was explored on 30-day mortality, intraoperative bleeding and perioperative transfusion requirements. Furthermore, the indications for APT were obtained. Measurements and Main Results Patients receiving APT (n = 73) did not have an increased 30-day mortality (29% v 20%, p = 0.18). However, APT increased intraoperative bleeding by 45% (p<0.001) and increased perioperative transfusion of red blood cells by 71%, fresh frozen plasma by 52%, and platelets by 56% (p = 0.002). Among patients receiving APT preoperatively, 26 patients received acetylsalicylic acid (ASA) alone and 46 patients received DAPT. Bleeding was significantly more pronounced in patients receiving DAPT (5.6±4.1 L), compared to ASA alone (3.6±3.1 L) and no APT (3.3±4.8 L) (p<0.001). However, there was no significant difference in mortality between groups. DAPT, including ticagrelor, increased intraoperative bleeding by 62% compared to DAPT with clopidogrel (p = 0.004). Among patients receiving DAPT, only 30% of the patients fulfilled ESC criteria for ACS treatment. Conclusions The use of APT was associated with increased intraoperative bleeding and transfusion requirement; however, it was not associated with a statistically significant increased mortality. Only a minority of patients fulfilled ESC criteria for ACS treatment with DAPT.

Original language	English
Journal	Journal of Cardiothoracic and Vascular Anesthesia
Volume	31
Issue number	2
Pages (from-to)	569-574
Number of pages	6
ISSN	1053-0770
DOIs	https://doi.org/10.1053/j.jvca.2016.10.007
Publication status	Published - 2017

Keywords

acute coronary syndromes
antiplatelet therapy
aortic dissection
aortic surgery
bleeding
outcome

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10.1053/j.jvca.2016.10.007

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@article{11ea7c9d07b848d5beceea17ae86c149,

title = "Outcome After Surgery for Acute Aortic Dissection: Influence of Preoperative Antiplatelet Therapy on Prognosis",

abstract = "Objectives Outcome in patients with acute coronary syndrome (ACS) is improved with dual antiplatelet therapy (DAPT). Patients with acute aortic dissection type A (AAD) often present with similar symptoms and may therefore be prescribed DAPT before diagnosis. The aim of this study was to evaluate the use of antiplatelet therapy (APT) prior to AAD surgery and patient outcome, including indications according to the European Society of Cardiology's (ESC) recent guidelines. Design A retrospective, observational study. Setting A tertiary University Hospital, Rigshospitalet, Heart Centre, Copenhagen, Denmark. Participants The study included 171 patients operated for AAD during 2010 to 2014. Interventions The independent relationship of preoperative APT was explored on 30-day mortality, intraoperative bleeding and perioperative transfusion requirements. Furthermore, the indications for APT were obtained. Measurements and Main Results Patients receiving APT (n = 73) did not have an increased 30-day mortality (29% v 20%, p = 0.18). However, APT increased intraoperative bleeding by 45% (p<0.001) and increased perioperative transfusion of red blood cells by 71%, fresh frozen plasma by 52%, and platelets by 56% (p = 0.002). Among patients receiving APT preoperatively, 26 patients received acetylsalicylic acid (ASA) alone and 46 patients received DAPT. Bleeding was significantly more pronounced in patients receiving DAPT (5.6±4.1 L), compared to ASA alone (3.6±3.1 L) and no APT (3.3±4.8 L) (p<0.001). However, there was no significant difference in mortality between groups. DAPT, including ticagrelor, increased intraoperative bleeding by 62% compared to DAPT with clopidogrel (p = 0.004). Among patients receiving DAPT, only 30% of the patients fulfilled ESC criteria for ACS treatment. Conclusions The use of APT was associated with increased intraoperative bleeding and transfusion requirement; however, it was not associated with a statistically significant increased mortality. Only a minority of patients fulfilled ESC criteria for ACS treatment with DAPT.",

keywords = "acute coronary syndromes, antiplatelet therapy, aortic dissection, aortic surgery, bleeding, outcome",

author = "Chemtob, {Raphaelle Avigael} and Hasse M{\o}ller-S{\o}rensen and Lene Holmvang and Olsen, {Peter Skov} and Ravn, {Hanne Berg}",

year = "2017",

doi = "10.1053/j.jvca.2016.10.007",

language = "English",

volume = "31",

pages = "569--574",

journal = "Journal of Cardiothoracic and Vascular Anesthesia",

issn = "1053-0770",

publisher = "W.B.Saunders Co.",

number = "2",

}

TY - JOUR

T1 - Outcome After Surgery for Acute Aortic Dissection

T2 - Influence of Preoperative Antiplatelet Therapy on Prognosis

AU - Chemtob, Raphaelle Avigael

AU - Møller-Sørensen, Hasse

AU - Holmvang, Lene

AU - Olsen, Peter Skov

AU - Ravn, Hanne Berg

PY - 2017

Y1 - 2017

N2 - Objectives Outcome in patients with acute coronary syndrome (ACS) is improved with dual antiplatelet therapy (DAPT). Patients with acute aortic dissection type A (AAD) often present with similar symptoms and may therefore be prescribed DAPT before diagnosis. The aim of this study was to evaluate the use of antiplatelet therapy (APT) prior to AAD surgery and patient outcome, including indications according to the European Society of Cardiology's (ESC) recent guidelines. Design A retrospective, observational study. Setting A tertiary University Hospital, Rigshospitalet, Heart Centre, Copenhagen, Denmark. Participants The study included 171 patients operated for AAD during 2010 to 2014. Interventions The independent relationship of preoperative APT was explored on 30-day mortality, intraoperative bleeding and perioperative transfusion requirements. Furthermore, the indications for APT were obtained. Measurements and Main Results Patients receiving APT (n = 73) did not have an increased 30-day mortality (29% v 20%, p = 0.18). However, APT increased intraoperative bleeding by 45% (p<0.001) and increased perioperative transfusion of red blood cells by 71%, fresh frozen plasma by 52%, and platelets by 56% (p = 0.002). Among patients receiving APT preoperatively, 26 patients received acetylsalicylic acid (ASA) alone and 46 patients received DAPT. Bleeding was significantly more pronounced in patients receiving DAPT (5.6±4.1 L), compared to ASA alone (3.6±3.1 L) and no APT (3.3±4.8 L) (p<0.001). However, there was no significant difference in mortality between groups. DAPT, including ticagrelor, increased intraoperative bleeding by 62% compared to DAPT with clopidogrel (p = 0.004). Among patients receiving DAPT, only 30% of the patients fulfilled ESC criteria for ACS treatment. Conclusions The use of APT was associated with increased intraoperative bleeding and transfusion requirement; however, it was not associated with a statistically significant increased mortality. Only a minority of patients fulfilled ESC criteria for ACS treatment with DAPT.

AB - Objectives Outcome in patients with acute coronary syndrome (ACS) is improved with dual antiplatelet therapy (DAPT). Patients with acute aortic dissection type A (AAD) often present with similar symptoms and may therefore be prescribed DAPT before diagnosis. The aim of this study was to evaluate the use of antiplatelet therapy (APT) prior to AAD surgery and patient outcome, including indications according to the European Society of Cardiology's (ESC) recent guidelines. Design A retrospective, observational study. Setting A tertiary University Hospital, Rigshospitalet, Heart Centre, Copenhagen, Denmark. Participants The study included 171 patients operated for AAD during 2010 to 2014. Interventions The independent relationship of preoperative APT was explored on 30-day mortality, intraoperative bleeding and perioperative transfusion requirements. Furthermore, the indications for APT were obtained. Measurements and Main Results Patients receiving APT (n = 73) did not have an increased 30-day mortality (29% v 20%, p = 0.18). However, APT increased intraoperative bleeding by 45% (p<0.001) and increased perioperative transfusion of red blood cells by 71%, fresh frozen plasma by 52%, and platelets by 56% (p = 0.002). Among patients receiving APT preoperatively, 26 patients received acetylsalicylic acid (ASA) alone and 46 patients received DAPT. Bleeding was significantly more pronounced in patients receiving DAPT (5.6±4.1 L), compared to ASA alone (3.6±3.1 L) and no APT (3.3±4.8 L) (p<0.001). However, there was no significant difference in mortality between groups. DAPT, including ticagrelor, increased intraoperative bleeding by 62% compared to DAPT with clopidogrel (p = 0.004). Among patients receiving DAPT, only 30% of the patients fulfilled ESC criteria for ACS treatment. Conclusions The use of APT was associated with increased intraoperative bleeding and transfusion requirement; however, it was not associated with a statistically significant increased mortality. Only a minority of patients fulfilled ESC criteria for ACS treatment with DAPT.

KW - acute coronary syndromes

KW - antiplatelet therapy

KW - aortic dissection

KW - aortic surgery

KW - bleeding

KW - outcome

U2 - 10.1053/j.jvca.2016.10.007

DO - 10.1053/j.jvca.2016.10.007

M3 - Journal article

C2 - 28017673

AN - SCOPUS:85010743386

SN - 1053-0770

VL - 31

SP - 569

EP - 574

JO - Journal of Cardiothoracic and Vascular Anesthesia

JF - Journal of Cardiothoracic and Vascular Anesthesia

IS - 2

ER -

Outcome After Surgery for Acute Aortic Dissection: Influence of Preoperative Antiplatelet Therapy on Prognosis

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