Evidence map›Paper›PMID 35258082›Full record

ArticleInteractive cardiovascular and thoracic surgery2022

Prior intake of new oral anticoagulants adversely affects outcome following surgery for acute type A aortic dissection.

Juri Sromicki, Mathias Van Hemelrijck, Martin O Schmiady, Bernard Krüger, Mohammed Morjan, Dominique Bettex, Paul R Vogt, Thierry P Carrel, Carlos-A Mestres

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Interactive cardiovascular and thoracic surgery, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
1.5field-weighted citation impact, top 17% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 10 citations in OpenAlex.

  1. Article
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  4. StandardizedFrontiers in cardiovascular medicine · 2023
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 1 institution in 1 country.

Juri SromickiDepartment of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland.ORCID 0000-0001-9964-7733
Mathias Van HemelrijckDepartment of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland.ORCID 0000-0002-0191-757X
Martin O SchmiadyDepartment of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland.ORCID 0000-0003-0210-7904
Bernard KrügerInstitute of Anesthesiology. University Hospital Zurich, Zurich, Switzerland.ORCID 0000-0002-1148-4376
Mohammed MorjanDepartment of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland.
Dominique BettexInstitute of Anesthesiology, University Zurich and University Hospital Zurich, Zurich, Switzerland.ORCID 0000-0002-3077-9524
Paul R VogtDepartment of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland.ORCID 0000-0001-9649-2940
Thierry P CarrelDepartment of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland.
Carlos-A MestresDepartment of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland.ORCID 0000-0001-8148-9044
University Hospital of Zurich · CH

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesOral anticoagulation prior to emergency surgery is associated with an increased risk of perioperative bleeding, especially when this therapy cannot be discontinued or reversed in time. The goal of this study was to analyse the impact of different oral anticoagulants on the outcome of patients who underwent emergency surgery for acute type A aortic dissection (ATAAD).

methodsThis was a single-centre retrospective study of patients treated with oral anticoagulation at the time of surgery for ATAAD. Outcomes of patients on new oral anticoagulant (NOAC) therapy were compared to respective outcomes of patients on Coumadin. Additionally, a survival analysis was performed comparing these 2 groups with patients who were operated on with no prior anticoagulation.

resultsBetween January 2013 and April 2020, a total of 437 patients (63.8 ± 11.8 years, 68.4% male) received emergency surgery for ATAAD; 35 (8%) were taking oral anticoagulation at the time of hospital admission: 20 received phenprocoumon; 14, rivaroxaban; and 1, dabigatran. Compared to Coumadin, NOAC was associated with a greater need for blood-product transfusions and haemodynamic compromise. Operative mortality was 53% in the NOAC group and 30% in the Coumadin group. A 5-year survival analysis showed no significant difference between the NOAC and the Coumadin group (P = 0.059). Compared to 402 patients treated during the study period without anticoagulation, patients taking NOAC had significantly worse survival (P = 0.001), whereas that effect was not observed in patients undergoing surgery who were taking Coumadin (P = 0.99).

conclusionsEmergency surgery for ATAAD in patients taking NOAC is associated with high morbidity and mortality. NOAC are a major risk factor for uncontrollable bleeding and haemodynamic compromise. New treatment strategies must be defined to improve surgical outcomes in these high-risk patients.

Indexed as

Aortic DissectionAtrial FibrillationAdministration, OralAnticoagulantsFemaleHemorrhageHumansMaleRetrospective StudiesWarfarinAnticoagulantsWarfarinAcute aortic syndromeAortic dissectionBleedingCoumadinDOACNOACOral anticoagulationType A dissection

Identifiers

PMID35258082
PMCPMC9252133
OpenAlexW4210885901

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.