Risk factors for coagulopathy after Stanford type A acute aortic dissection repair_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Shuwen ¹ , YANG Yanwei ¹ , LU Jiakai ¹ , CHENG Weiping ¹ ,  JIN Mu ^1,2

1. Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Disease, Capital Medical University, Beijing, 100029, P.R.China;
2. Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100069, P.R.China;

Corresponding author：

JIN Mu, Email: jinmu0119@hotmail.com

Keywords：

Aortic dissection; surgery; coagulopathy

DOI：

10.7507/1007-4848.201712021

Video：

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Objective To identify the risk factors for coagulopathy after Stanford type A acute aortic dissection (AAD) repair to offer evidence for improvement of patients' prognosis. Methods We retrospectively analyzed the clinical data of 95 patients undergoing Stanford type A AAD repair in Beijing Anzhen Hospital between January 2013 and December 2014. Patients with thromboelastography-coagulation index (TEG-CI) ≤–3 after surgery were allocated to a coagulopathy group (n=17, average age 48.70 years), whereas patients with TEG-CI >–3 after surgery were allocated to a control group ( n=78, average age 46.80 years). Multivariate analysis was used to identify risk factors for coagulopathy after surgery. Results Seventeen patients suffered from coagulopathy after surgery. Patients in the coagulopathy group had larger amount of fluid drainage than that in the control group (P=0.008). Risk factors for postoperative coagulopathy were activated partial thromboplastin time (APTT) at the end of surgery ( OR=0.011, 95% confidence interval 0.001 to 0.021, P=0.035), fibrinogen degradation products (FDP) at the end of surgery (OR=0.004, 95% confidence interval 0.001 to 0.007, P=0.022) and platelet count (×10⁹/L) at the end of surgery (OR=–0.002, 95% confidence interval –0.003 to 0.000, P=0.049). The lower risk of postoperative coagulopathy was related to the platelet count at the end of surgery up to 137.00 ×10⁹/L. Conclusion Postoperative coagulopathy could be related to the clinical and experimental variables. In a representative sample of Chinese adults undergoing Stanford type A AAD surgery, APTT, FDP and platelet count at the end of surgery are independent risk factors associated with postoperative coagulopathy. Adding haemostatic, such as fibrinogen and prothrombinase complex, is good for improving the recovery of coagulation function to reduce bleeding and postoperative blood transfusion, as well as adding platelet, plasma and other coagulation factors after AAD surgery.

Citation： LI Shuwen, YANG Yanwei, LU Jiakai, CHENG Weiping, JIN Mu. Risk factors for coagulopathy after Stanford type A acute aortic dissection repair. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(8): 670-675. doi: 10.7507/1007-4848.201712021 Copy

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2.	Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA, 2000, 283(7): 897-903.
3.	Reddy SL, Grayson AD, Griffiths EM. Logistic risk model for prolonged ventilation after adult cardiac surgery. Ann Thorac surg, 2007, 84(2): 528-536.
4.	Paparella D, Rotunno C, Guida P, et al. Hemostasis alterations in patients with acute aortic dissection. Ann Thorac surg, 2011, 91(5): 1364-1369.
5.	Guan XL, Wang XL, Liu YY, et al. Changes in the hemostatic dystem of patients eith acute aortic dissection undergoing aortic arch surgery. Ann Thorac surg, 2016, 101(3): 945-951.
6.	Liu Y, Han L, Li J, et al. Consumption coagulopathy in acute aortic dissection: principles of management. J Cardiothorac Surg, 2017, 12(1): 50.
7.	Sun L, Qi R, Zhu J. Total arch replacement combined with stented elephant trunk implantation: a new " standard” therapy for type A dissection involving repair of the aortic arch? Circulation, 2011, 123(9): 971-978.
8.	Sun L, Qi R, Zhu J, et al. Repair of acute type A dissection: our experiences and results. Ann Thorac Surg, 2011; 91(4): 1147-1152.
9.	Bolliger D, Seeberger MD, Tanaka KA. Principles and practice of thromboelastography in clinical coagulation management and transfusion practice. Transfus Med Rev, 2012, 26(1): 1-13.
10.	Wikkelso A, Wetterslev J, Moller AM, Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding. Cochrane Database Syst Rev, 2016, 8: Cd007871.
11.	Deppe AC, Weber C, Zimmermann J, et al. Point-of-care thromboelastography/thromboelastometry-based coagulation management in cardiac surgery: a meta-analysis of 8332 patients. J Surg Res, 2016, 203(2): 424-33.
12.	Zhang S, Qian H, Yang Q. Relationship between the extent of dissection and platelet activation in acute aortic dissection. J Cardiothorac Surg, 2015, 10: 162.
13.	Qin C, Zhang H, Gu J. Dynamic monitoring of platelet activation and its role in post-dissection inflammation in a canine model of acute type A aortic dissection. J Cardiothorac Surg, 2016, 11(1): 86.
14.	Besser MW, Klein AA. The coagulopathy of cardiopulmonary bypass. Crit Rev Clin Lab Sci, 2010, 47(5-6): 197-212.
15.	Ferraris VA, Ferraris SP, Saha SP, et al. Perioperative blood transfusion and blood conservation in cardiac surgery: the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists clinical practice guideline. Ann Thorac Surg, 2007, 83(5 Suppl): S27-86.

1. Golledge J, Eagle KA. Acute aortic dissection. Lancet, 2008, 372(9632): 55-66.
2. Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA, 2000, 283(7): 897-903.
3. Reddy SL, Grayson AD, Griffiths EM. Logistic risk model for prolonged ventilation after adult cardiac surgery. Ann Thorac surg, 2007, 84(2): 528-536.
4. Paparella D, Rotunno C, Guida P, et al. Hemostasis alterations in patients with acute aortic dissection. Ann Thorac surg, 2011, 91(5): 1364-1369.
5. Guan XL, Wang XL, Liu YY, et al. Changes in the hemostatic dystem of patients eith acute aortic dissection undergoing aortic arch surgery. Ann Thorac surg, 2016, 101(3): 945-951.
6. Liu Y, Han L, Li J, et al. Consumption coagulopathy in acute aortic dissection: principles of management. J Cardiothorac Surg, 2017, 12(1): 50.
7. Sun L, Qi R, Zhu J. Total arch replacement combined with stented elephant trunk implantation: a new " standard” therapy for type A dissection involving repair of the aortic arch? Circulation, 2011, 123(9): 971-978.
8. Sun L, Qi R, Zhu J, et al. Repair of acute type A dissection: our experiences and results. Ann Thorac Surg, 2011; 91(4): 1147-1152.
9. Bolliger D, Seeberger MD, Tanaka KA. Principles and practice of thromboelastography in clinical coagulation management and transfusion practice. Transfus Med Rev, 2012, 26(1): 1-13.
10. Wikkelso A, Wetterslev J, Moller AM, Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding. Cochrane Database Syst Rev, 2016, 8: Cd007871.
11. Deppe AC, Weber C, Zimmermann J, et al. Point-of-care thromboelastography/thromboelastometry-based coagulation management in cardiac surgery: a meta-analysis of 8332 patients. J Surg Res, 2016, 203(2): 424-33.
12. Zhang S, Qian H, Yang Q. Relationship between the extent of dissection and platelet activation in acute aortic dissection. J Cardiothorac Surg, 2015, 10: 162.
13. Qin C, Zhang H, Gu J. Dynamic monitoring of platelet activation and its role in post-dissection inflammation in a canine model of acute type A aortic dissection. J Cardiothorac Surg, 2016, 11(1): 86.
14. Besser MW, Klein AA. The coagulopathy of cardiopulmonary bypass. Crit Rev Clin Lab Sci, 2010, 47(5-6): 197-212.
15. Ferraris VA, Ferraris SP, Saha SP, et al. Perioperative blood transfusion and blood conservation in cardiac surgery: the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists clinical practice guideline. Ann Thorac Surg, 2007, 83(5 Suppl): S27-86.

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