Perioperative Hemostatic Management of Patients with Type A Aortic Dissection

Overview

Journal Front Cardiovasc Med

Specialty Cardiology & Vascular Diseases

Date 2023 Dec 6

PMID 38054097

Authors

Gabor Erdoes

Aamer Ahmed

Stephan D Kurz

Daniel Gerber

Daniel Bolliger

Affiliations

Soon will be listed here.

Abstract

Coagulopathy is common in patients undergoing thoracic aortic repair for Stanford type A aortic dissection. Non-critical administration of blood products may adversely affect the outcome. It is therefore important to be familiar with the pathologic conditions that lead to coagulopathy in complex cardiac surgery. Adequate care of these patients includes the collection of the medical history regarding the use of antithrombotic and anticoagulant drugs, and a sophisticated diagnosis of the coagulopathy with viscoelastic testing and subsequently adapted coagulation therapy with labile and stable blood products. In addition to the above-mentioned measures, intraoperative blood conservation measures as well as good interdisciplinary coordination and communication contribute to a successful hemostatic management strategy.

Citing Articles

The Role of Viscoelastic Testing in Assessing Hemostasis: A Challenge to Standard Laboratory Assays?.

Reardon B, Pasalic L, Favaloro E J Clin Med. 2024; 13(12).

PMID: 38930139 PMC: 11205135. DOI: 10.3390/jcm13123612.

Analysis of the hemostatic effect of preset wrapping technique for type A aortic dissection with abnormal coagulation.

Cai Z, Yan T, Zhang B, Zhang W, Su C, Chen H J Thorac Dis. 2024; 16(2):1223-1233.

PMID: 38505007 PMC: 10944749. DOI: 10.21037/jtd-23-1581.

References

Liu J, Sun L, Wang J, Ji G . The relationship between fibrinogen and in-hospital mortality in patients with type A acute aortic dissection. Am J Emerg Med. 2017; 36(5):741-744. DOI: 10.1016/j.ajem.2017.10.001. View

Henry D, Carless P, Moxey A, OCONNELL D, Stokes B, McClelland B . Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev. 2007; (4):CD001886. DOI: 10.1002/14651858.CD001886.pub2. View

Huang B, Tian L, Fan X, Zhu J, Liang Y, Yang Y . Low admission platelet counts predicts increased risk of in-hospital mortality in patients with type A acute aortic dissection. Int J Cardiol. 2014; 172(3):e484-6. DOI: 10.1016/j.ijcard.2014.01.001. View

Bolliger D, Mauermann E, Erdoes G . A New Tool in the Management of Direct-Acting Oral Anticoagulants in Emergency Cardiac Surgery. J Cardiothorac Vasc Anesth. 2022; 36(6):1645-1647. DOI: 10.1053/j.jvca.2022.02.034. View

Ebner M, Birschmann I, Peter A, Hartig F, Spencer C, Kuhn J . Emergency Coagulation Assessment During Treatment With Direct Oral Anticoagulants: Limitations and Solutions. Stroke. 2017; 48(9):2457-2463. DOI: 10.1161/STROKEAHA.117.017981. View

Boissier E, Senage T, Babuty A, Gouin-Thibault I, Rozec B, Roussel J . Heparin Anti-Xa Activity, a Readily Available Unique Test to Quantify Apixaban, Rivaroxaban, Fondaparinux, and Danaparoid Levels. Anesth Analg. 2020; 132(3):707-716. DOI: 10.1213/ANE.0000000000005114. View

Fassl J, Matt P, Eckstein F, Filipovic M, Gregor M, Zenklusen U . Transfusion of allogeneic blood products in proximal aortic surgery with hypothermic circulatory arrest: effect of thromboelastometry-guided transfusion management. J Cardiothorac Vasc Anesth. 2013; 27(6):1181-8. DOI: 10.1053/j.jvca.2013.02.009. View

Nazerian P, Mueller C, de Matos Soeiro A, Leidel B, Salvadeo S, Giachino F . Diagnostic Accuracy of the Aortic Dissection Detection Risk Score Plus D-Dimer for Acute Aortic Syndromes: The ADvISED Prospective Multicenter Study. Circulation. 2017; 137(3):250-258. DOI: 10.1161/CIRCULATIONAHA.117.029457. View

Ng W, Jerath A, Wasowicz M . Tranexamic acid: a clinical review. Anaesthesiol Intensive Ther. 2015; 47(4):339-50. DOI: 10.5603/AIT.a2015.0011. View

10.

Scolletta S, Simioni P, Campagnolo V, Celiento M, Fontanari P, Guadagnucci A . Patient blood management in cardiac surgery: The "Granducato algorithm". Int J Cardiol. 2019; 289:37-42. DOI: 10.1016/j.ijcard.2019.01.025. View

11.

Li M, Xu S, Yan Y, Wang H, Zheng J, Li Y . Association of biomarkers related to preoperative inflammatory and coagulation with postoperative in-hospital deaths in patients with type A acute aortic dissection. Sci Rep. 2021; 11(1):18775. PMC: 8455536. DOI: 10.1038/s41598-021-98298-w. View

12.

Bolliger D, Tanaka K . Which Came First, the Chicken or the Egg?-Clinical Dilemmas in Managing Postoperative Bleeding and Decision-making for Re-exploration After Cardiac Surgery. J Cardiothorac Vasc Anesth. 2018; 32(4):1625-1626. DOI: 10.1053/j.jvca.2018.01.010. View

13.

Sharma V, Katznelson R, Jerath A, Garrido-Olivares L, Carroll J, Rao V . The association between tranexamic acid and convulsive seizures after cardiac surgery: a multivariate analysis in 11 529 patients. Anaesthesia. 2014; 69(2):124-30. DOI: 10.1111/anae.12516. View

14.

Shi J, Zhou C, Pan W, Sun H, Liu S, Feng W . Effect of High- vs Low-Dose Tranexamic Acid Infusion on Need for Red Blood Cell Transfusion and Adverse Events in Patients Undergoing Cardiac Surgery: The OPTIMAL Randomized Clinical Trial. JAMA. 2022; 328(4):336-347. PMC: 9327582. DOI: 10.1001/jama.2022.10725. View

15.

Kincaid E, Jones T, Stump D, Brown W, Moody D, Deal D . Processing scavenged blood with a cell saver reduces cerebral lipid microembolization. Ann Thorac Surg. 2000; 70(4):1296-300. DOI: 10.1016/s0003-4975(00)01588-5. View

16.

Apostolakis E, Koletsis E, Baikoussis N, Siminelakis S, Papadopoulos G . Strategies to prevent intraoperative lung injury during cardiopulmonary bypass. J Cardiothorac Surg. 2010; 5:1. PMC: 2823729. DOI: 10.1186/1749-8090-5-1. View

17.

Bolliger D, Gorlinger K, Tanaka K . Pathophysiology and treatment of coagulopathy in massive hemorrhage and hemodilution. Anesthesiology. 2010; 113(5):1205-19. DOI: 10.1097/ALN.0b013e3181f22b5a. View

18.

Geirsson A, Ahlsson A, Franco-Cereceda A, Fuglsang S, Gunn J, Hansson E . Hospital volumes and later year of operation correlates with better outcomes in acute Type A aortic dissection. Eur J Cardiothorac Surg. 2017; 53(1):276-281. DOI: 10.1093/ejcts/ezx231. View

19.

Koster A, Hulde N, Deutsch M, Gummert J, von Dossow V, Zittermann A . The Efficacy and Safety of a Low-Dose Tranexamic Acid Bolus-Only Protocol Compared with the Moderate-Dose Protocol in Valvular Heart Surgery. Thorac Cardiovasc Surg. 2023; 72(1):55-58. DOI: 10.1055/s-0042-1760205. View

20.

Tanaka M, Kawahito K, Adachi H, Ino T . Platelet dysfunction in acute type A aortic dissection evaluated by the laser light-scattering method. J Thorac Cardiovasc Surg. 2003; 126(3):837-41. DOI: 10.1016/s0022-5223(03)00734-7. View