ORal anticoagulation risks late aortic intervention in Conservatively managed type B Aortic dissection (ORCA study)
Abstract 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 Jan...
Published in: | European Journal of Cardio-Thoracic Surgery |
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Oxford University Press (OUP)
2022
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croxfordunivpr:10.1093/ejcts/ezac495 2024-09-15T18:28:59+00:00 ORal anticoagulation risks late aortic intervention in Conservatively managed type B Aortic dissection (ORCA study) Jesse, Katarzyna Meuli, Lorenz Kopp, Reinhard Reutersberg, Benedikt Stadlbauer, Thomas Zimmermann, Alexander Dueppers, Philip 2022 http://dx.doi.org/10.1093/ejcts/ezac495 https://academic.oup.com/ejcts/advance-article-pdf/doi/10.1093/ejcts/ezac495/46352024/ezac495.pdf https://academic.oup.com/ejcts/article-pdf/62/5/ezac495/46695330/ezac495.pdf en eng Oxford University Press (OUP) https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model European Journal of Cardio-Thoracic Surgery volume 62, issue 5 ISSN 1873-734X journal-article 2022 croxfordunivpr https://doi.org/10.1093/ejcts/ezac495 2024-07-29T04:22:00Z Abstract 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. Article in Journal/Newspaper Orca Oxford University Press European Journal of Cardio-Thoracic Surgery |
institution |
Open Polar |
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Oxford University Press |
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croxfordunivpr |
language |
English |
description |
Abstract 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. |
format |
Article in Journal/Newspaper |
author |
Jesse, Katarzyna Meuli, Lorenz Kopp, Reinhard Reutersberg, Benedikt Stadlbauer, Thomas Zimmermann, Alexander Dueppers, Philip |
spellingShingle |
Jesse, Katarzyna Meuli, Lorenz Kopp, Reinhard Reutersberg, Benedikt Stadlbauer, Thomas Zimmermann, Alexander Dueppers, Philip ORal anticoagulation risks late aortic intervention in Conservatively managed type B Aortic dissection (ORCA study) |
author_facet |
Jesse, Katarzyna Meuli, Lorenz Kopp, Reinhard Reutersberg, Benedikt Stadlbauer, Thomas Zimmermann, Alexander Dueppers, Philip |
author_sort |
Jesse, Katarzyna |
title |
ORal anticoagulation risks late aortic intervention in Conservatively managed type B Aortic dissection (ORCA study) |
title_short |
ORal anticoagulation risks late aortic intervention in Conservatively managed type B Aortic dissection (ORCA study) |
title_full |
ORal anticoagulation risks late aortic intervention in Conservatively managed type B Aortic dissection (ORCA study) |
title_fullStr |
ORal anticoagulation risks late aortic intervention in Conservatively managed type B Aortic dissection (ORCA study) |
title_full_unstemmed |
ORal anticoagulation risks late aortic intervention in Conservatively managed type B Aortic dissection (ORCA study) |
title_sort |
oral anticoagulation risks late aortic intervention in conservatively managed type b aortic dissection (orca study) |
publisher |
Oxford University Press (OUP) |
publishDate |
2022 |
url |
http://dx.doi.org/10.1093/ejcts/ezac495 https://academic.oup.com/ejcts/advance-article-pdf/doi/10.1093/ejcts/ezac495/46352024/ezac495.pdf https://academic.oup.com/ejcts/article-pdf/62/5/ezac495/46695330/ezac495.pdf |
genre |
Orca |
genre_facet |
Orca |
op_source |
European Journal of Cardio-Thoracic Surgery volume 62, issue 5 ISSN 1873-734X |
op_rights |
https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model |
op_doi |
https://doi.org/10.1093/ejcts/ezac495 |
container_title |
European Journal of Cardio-Thoracic Surgery |
_version_ |
1810470408827174912 |