Preoperative dual antiplatelet therapy increases bleeding and transfusions but not mortality in acute aortic dissection type A repair.
To access publisher's full text version of this article click on the hyperlink below OBJECTIVES: Acute aortic dissection type A is a life-threatening condition, warranting immediate surgery. Presentation with sudden chest pain confers a risk of misdiagnosis as acute coronary syndrome resulting...
Published in: | European Journal of Cardio-Thoracic Surgery |
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Main Authors: | , , , , , , , , , , , , |
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Format: | Article in Journal/Newspaper |
Language: | English |
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Oxford University Press
2019
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Online Access: | http://hdl.handle.net/2336/621175 https://doi.org/10.1093/ejcts/ezy469 |
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ftlandspitaliuni:oai:www.hirsla.lsh.is:2336/621175 |
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Hirsla - Landspítali University Hospital research archive |
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ftlandspitaliuni |
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English |
topic |
Acute aortic dissection Antiplatelet agents Bleeding complications Ósæðargúll Blæðingar (áverkar) Skurðlækningar Platelet Aggregation Inhibitors Aneurysm Dissecting Hemorrhage |
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Acute aortic dissection Antiplatelet agents Bleeding complications Ósæðargúll Blæðingar (áverkar) Skurðlækningar Platelet Aggregation Inhibitors Aneurysm Dissecting Hemorrhage Hansson, Emma C Geirsson, Arnar Hjortdal, Vibeke Mennander, Ari Olsson, Christian Gunn, Jarmo Zindovic, Igor Ahlsson, Anders Nozohoor, Shahab Chemtob, Raphaelle A Pivodic, Aldina Gudbjartsson, Tomas Jeppsson, Anders Preoperative dual antiplatelet therapy increases bleeding and transfusions but not mortality in acute aortic dissection type A repair. |
topic_facet |
Acute aortic dissection Antiplatelet agents Bleeding complications Ósæðargúll Blæðingar (áverkar) Skurðlækningar Platelet Aggregation Inhibitors Aneurysm Dissecting Hemorrhage |
description |
To access publisher's full text version of this article click on the hyperlink below OBJECTIVES: Acute aortic dissection type A is a life-threatening condition, warranting immediate surgery. Presentation with sudden chest pain confers a risk of misdiagnosis as acute coronary syndrome resulting in subsequent potent antiplatelet treatment. We investigated the impact of dual antiplatelet therapy (DAPT) on bleeding and mortality using the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) database. METHODS: The NORCAAD database is a retrospective multicentre database where 119 of 1141 patients (10.4%) had DAPT with ASA + clopidogrel (n = 108) or ASA + ticagrelor (n = 11) before surgery. The incidence of major bleeding and 30-day mortality was compared between DAPT and non-DAPT patients with logistic regression models before and after propensity score matching. RESULTS: Before matching, 51.3% of DAPT patients had major bleeding when compared to 37.7% of non-DAPT patients (P = 0.0049). DAPT patients received more transfusions of red blood cells [median 8 U (Q1-Q3 4-15) vs 5.5 U (2-11), P < 0.0001] and platelets [4 U (2-8) vs 2 U (1-4), P = 0.0001]. Crude 30-day mortality was 19.3% vs 17.0% (P = 0.60). After matching, major bleeding remained significantly more common in DAPT patients, 51.3% vs 39.3% [odds ratio (OR) 1.63, 95% confidence interval (CI) 1.05-2.51; P = 0.028], but mortality did not significantly differ (OR 0.88, 95% CI 0.51-1.50; P = 0.63). Major bleeding was associated with increased 30-day mortality (adjusted OR 2.44, 95% CI 1.72-3.46; P < 0.0001). CONCLUSIONS: DAPT prior to acute aortic dissection repair was associated with increased bleeding and transfusions but not with mortality. Major bleeding per se was associated with a significantly increased mortality. Correct diagnosis is important to avoid DAPT and thereby reduce bleeding risk, but ongoing DAPT should not delay surgery. Swedish Heart-Lung Foundation University of Iceland Research Fund the Landspitali Research Fund Mats ... |
author2 |
1 Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden. 2 Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 3 Department of Cardiothoracic Surgery, Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland. 4 Section of Cardiac Surgery, Yale University School of Medicine, New Haven, CT, USA. 5 Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Denmark. 6 Department of Cardiothoracic Surgery, Heart Center Tampere University Hospital, Tampere, Finland. 7 Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden. 8 Department of Surgery, Heart Center, Turku University Hospital, University of Turku, Turku, Finland. 9 Department of Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden. 10 Department of Cardiothoracic Surgery, Lund University, Skane University Hospital, Lund, Sweden. 11 Department of Heart and Vascular Theme, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden. 12 Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. 13 Statistiska konsultgruppen, Gothenburg, Sweden. |
format |
Article in Journal/Newspaper |
author |
Hansson, Emma C Geirsson, Arnar Hjortdal, Vibeke Mennander, Ari Olsson, Christian Gunn, Jarmo Zindovic, Igor Ahlsson, Anders Nozohoor, Shahab Chemtob, Raphaelle A Pivodic, Aldina Gudbjartsson, Tomas Jeppsson, Anders |
author_facet |
Hansson, Emma C Geirsson, Arnar Hjortdal, Vibeke Mennander, Ari Olsson, Christian Gunn, Jarmo Zindovic, Igor Ahlsson, Anders Nozohoor, Shahab Chemtob, Raphaelle A Pivodic, Aldina Gudbjartsson, Tomas Jeppsson, Anders |
author_sort |
Hansson, Emma C |
title |
Preoperative dual antiplatelet therapy increases bleeding and transfusions but not mortality in acute aortic dissection type A repair. |
title_short |
Preoperative dual antiplatelet therapy increases bleeding and transfusions but not mortality in acute aortic dissection type A repair. |
title_full |
Preoperative dual antiplatelet therapy increases bleeding and transfusions but not mortality in acute aortic dissection type A repair. |
title_fullStr |
Preoperative dual antiplatelet therapy increases bleeding and transfusions but not mortality in acute aortic dissection type A repair. |
title_full_unstemmed |
Preoperative dual antiplatelet therapy increases bleeding and transfusions but not mortality in acute aortic dissection type A repair. |
title_sort |
preoperative dual antiplatelet therapy increases bleeding and transfusions but not mortality in acute aortic dissection type a repair. |
publisher |
Oxford University Press |
publishDate |
2019 |
url |
http://hdl.handle.net/2336/621175 https://doi.org/10.1093/ejcts/ezy469 |
genre |
Iceland |
genre_facet |
Iceland |
op_source |
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery |
op_relation |
https://academic.oup.com/ejcts/article-abstract/56/1/182/5290000?redirectedFrom=fulltext Hansson EC, Geirsson A, Hjortdal V, Mennander A, Olsson C, Gunn J, Zindovic I, Ahlsson A, Nozohoor S, Chemtob RA, Pivodic A. Preoperative dual antiplatelet therapy increases bleeding and transfusions but not mortality in acute aortic dissection type A repair. European Journal of Cardio-Thoracic Surgery. 2019 Jan 16;56(1):182-8. 1873-734X 30657880 doi:10.1093/ejcts/ezy469 http://hdl.handle.net/2336/621175 European Journal of Cardiothoracic Surgery |
op_rights |
Landspitali Access - LSH-aðgangur |
op_doi |
https://doi.org/10.1093/ejcts/ezy469 |
container_title |
European Journal of Cardio-Thoracic Surgery |
container_volume |
56 |
container_issue |
1 |
container_start_page |
182 |
op_container_end_page |
188 |
_version_ |
1766043201268875264 |
spelling |
ftlandspitaliuni:oai:www.hirsla.lsh.is:2336/621175 2023-05-15T16:52:47+02:00 Preoperative dual antiplatelet therapy increases bleeding and transfusions but not mortality in acute aortic dissection type A repair. Hansson, Emma C Geirsson, Arnar Hjortdal, Vibeke Mennander, Ari Olsson, Christian Gunn, Jarmo Zindovic, Igor Ahlsson, Anders Nozohoor, Shahab Chemtob, Raphaelle A Pivodic, Aldina Gudbjartsson, Tomas Jeppsson, Anders 1 Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden. 2 Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 3 Department of Cardiothoracic Surgery, Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland. 4 Section of Cardiac Surgery, Yale University School of Medicine, New Haven, CT, USA. 5 Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Denmark. 6 Department of Cardiothoracic Surgery, Heart Center Tampere University Hospital, Tampere, Finland. 7 Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden. 8 Department of Surgery, Heart Center, Turku University Hospital, University of Turku, Turku, Finland. 9 Department of Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden. 10 Department of Cardiothoracic Surgery, Lund University, Skane University Hospital, Lund, Sweden. 11 Department of Heart and Vascular Theme, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden. 12 Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. 13 Statistiska konsultgruppen, Gothenburg, Sweden. 2019-11 http://hdl.handle.net/2336/621175 https://doi.org/10.1093/ejcts/ezy469 en eng Oxford University Press https://academic.oup.com/ejcts/article-abstract/56/1/182/5290000?redirectedFrom=fulltext Hansson EC, Geirsson A, Hjortdal V, Mennander A, Olsson C, Gunn J, Zindovic I, Ahlsson A, Nozohoor S, Chemtob RA, Pivodic A. Preoperative dual antiplatelet therapy increases bleeding and transfusions but not mortality in acute aortic dissection type A repair. European Journal of Cardio-Thoracic Surgery. 2019 Jan 16;56(1):182-8. 1873-734X 30657880 doi:10.1093/ejcts/ezy469 http://hdl.handle.net/2336/621175 European Journal of Cardiothoracic Surgery Landspitali Access - LSH-aðgangur European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery Acute aortic dissection Antiplatelet agents Bleeding complications Ósæðargúll Blæðingar (áverkar) Skurðlækningar Platelet Aggregation Inhibitors Aneurysm Dissecting Hemorrhage Article 2019 ftlandspitaliuni https://doi.org/10.1093/ejcts/ezy469 2022-05-29T08:22:29Z To access publisher's full text version of this article click on the hyperlink below OBJECTIVES: Acute aortic dissection type A is a life-threatening condition, warranting immediate surgery. Presentation with sudden chest pain confers a risk of misdiagnosis as acute coronary syndrome resulting in subsequent potent antiplatelet treatment. We investigated the impact of dual antiplatelet therapy (DAPT) on bleeding and mortality using the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) database. METHODS: The NORCAAD database is a retrospective multicentre database where 119 of 1141 patients (10.4%) had DAPT with ASA + clopidogrel (n = 108) or ASA + ticagrelor (n = 11) before surgery. The incidence of major bleeding and 30-day mortality was compared between DAPT and non-DAPT patients with logistic regression models before and after propensity score matching. RESULTS: Before matching, 51.3% of DAPT patients had major bleeding when compared to 37.7% of non-DAPT patients (P = 0.0049). DAPT patients received more transfusions of red blood cells [median 8 U (Q1-Q3 4-15) vs 5.5 U (2-11), P < 0.0001] and platelets [4 U (2-8) vs 2 U (1-4), P = 0.0001]. Crude 30-day mortality was 19.3% vs 17.0% (P = 0.60). After matching, major bleeding remained significantly more common in DAPT patients, 51.3% vs 39.3% [odds ratio (OR) 1.63, 95% confidence interval (CI) 1.05-2.51; P = 0.028], but mortality did not significantly differ (OR 0.88, 95% CI 0.51-1.50; P = 0.63). Major bleeding was associated with increased 30-day mortality (adjusted OR 2.44, 95% CI 1.72-3.46; P < 0.0001). CONCLUSIONS: DAPT prior to acute aortic dissection repair was associated with increased bleeding and transfusions but not with mortality. Major bleeding per se was associated with a significantly increased mortality. Correct diagnosis is important to avoid DAPT and thereby reduce bleeding risk, but ongoing DAPT should not delay surgery. Swedish Heart-Lung Foundation University of Iceland Research Fund the Landspitali Research Fund Mats ... Article in Journal/Newspaper Iceland Hirsla - Landspítali University Hospital research archive European Journal of Cardio-Thoracic Surgery 56 1 182 188 |