ORal anticoagulation risks late aortic intervention in Conservatively managed type B Aortic dissection (ORCA study)
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 20...
Published in: | Ophthalmic and Physiological Optics |
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Oxford University Press
2022
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Online Access: | https://www.zora.uzh.ch/id/eprint/228163/ https://www.zora.uzh.ch/id/eprint/228163/1/ezac495.pdf https://doi.org/10.5167/uzh-228163 https://doi.org/10.1093/ejcts/ezac495 |
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ftunivzuerich:oai:www.zora.uzh.ch:228163 2024-06-23T07:55:59+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 2022-10-04 application/pdf https://www.zora.uzh.ch/id/eprint/228163/ https://www.zora.uzh.ch/id/eprint/228163/1/ezac495.pdf https://doi.org/10.5167/uzh-228163 https://doi.org/10.1093/ejcts/ezac495 eng eng Oxford University Press https://www.zora.uzh.ch/id/eprint/228163/1/ezac495.pdf doi:10.5167/uzh-228163 doi:10.1093/ejcts/ezac495 info:pmid/36200847 urn:issn:1010-7940 info:eu-repo/semantics/closedAccess Jesse, Katarzyna; Meuli, Lorenz; Kopp, Reinhard; Reutersberg, Benedikt; Stadlbauer, Thomas; Zimmermann, Alexander; Dueppers, Philip (2022). ORal anticoagulation risks late aortic intervention in Conservatively managed type B Aortic dissection (ORCA study). European Journal of Cardio-Thoracic Surgery, 62(5):ezac495. Clinic for Vascular Surgery 610 Medicine & health Cardiology and Cardiovascular Medicine Pulmonary and Respiratory Medicine General Medicine Surgery Journal Article PeerReviewed info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion 2022 ftunivzuerich https://doi.org/10.5167/uzh-22816310.1093/ejcts/ezac495 2024-06-05T00:25:17Z 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. Keywords: Anticoagulant drugs; Anticoagulation; Antiplatelet therapy; Aortic dissection; Conservative management; Endovascular therapy. Article in Journal/Newspaper Orca University of Zurich (UZH): ZORA (Zurich Open Repository and Archive Ophthalmic and Physiological Optics 37 2 141 150 |
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University of Zurich (UZH): ZORA (Zurich Open Repository and Archive |
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ftunivzuerich |
language |
English |
topic |
Clinic for Vascular Surgery 610 Medicine & health Cardiology and Cardiovascular Medicine Pulmonary and Respiratory Medicine General Medicine Surgery |
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Clinic for Vascular Surgery 610 Medicine & health Cardiology and Cardiovascular Medicine Pulmonary and Respiratory Medicine General Medicine Surgery 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) |
topic_facet |
Clinic for Vascular Surgery 610 Medicine & health Cardiology and Cardiovascular Medicine Pulmonary and Respiratory Medicine General Medicine Surgery |
description |
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. Keywords: Anticoagulant drugs; Anticoagulation; Antiplatelet therapy; Aortic dissection; Conservative management; Endovascular therapy. |
format |
Article in Journal/Newspaper |
author |
Jesse, Katarzyna Meuli, Lorenz Kopp, Reinhard Reutersberg, Benedikt Stadlbauer, Thomas Zimmermann, Alexander Dueppers, Philip |
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 |
publishDate |
2022 |
url |
https://www.zora.uzh.ch/id/eprint/228163/ https://www.zora.uzh.ch/id/eprint/228163/1/ezac495.pdf https://doi.org/10.5167/uzh-228163 https://doi.org/10.1093/ejcts/ezac495 |
genre |
Orca |
genre_facet |
Orca |
op_source |
Jesse, Katarzyna; Meuli, Lorenz; Kopp, Reinhard; Reutersberg, Benedikt; Stadlbauer, Thomas; Zimmermann, Alexander; Dueppers, Philip (2022). ORal anticoagulation risks late aortic intervention in Conservatively managed type B Aortic dissection (ORCA study). European Journal of Cardio-Thoracic Surgery, 62(5):ezac495. |
op_relation |
https://www.zora.uzh.ch/id/eprint/228163/1/ezac495.pdf doi:10.5167/uzh-228163 doi:10.1093/ejcts/ezac495 info:pmid/36200847 urn:issn:1010-7940 |
op_rights |
info:eu-repo/semantics/closedAccess |
op_doi |
https://doi.org/10.5167/uzh-22816310.1093/ejcts/ezac495 |
container_title |
Ophthalmic and Physiological Optics |
container_volume |
37 |
container_issue |
2 |
container_start_page |
141 |
op_container_end_page |
150 |
_version_ |
1802648815214264320 |