Preoperative dual antiplatelet therapy increases bleeding and transfusions but not mortality in acute aortic dissection type A repair - UTU Research Portal

A1 Refereed original research article in a scientific journal

Preoperative dual antiplatelet therapy increases bleeding and transfusions but not mortality in acute aortic dissection type A repair

Authors: Hansson EC, Geirsson A, Hjortdal V, Mennander A, Olsson C, Gunn J, Zindovic I, Ahlsson A, Nozohoor S, Chemtob RA, Pivodic A, Gudbjartsson T, Jeppsson A; on behalf of the NORCAAD collaboration

Publication year: 2019

Journal: European Journal of Cardio-Thoracic Surgery

Volume: 56

Issue: 1

First page : 182

Last page: 188

Number of pages: 7

ISSN: 1010-7940

DOI: https://doi.org/10.1093/ejcts/ezy469

Abstract

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.