ArticleJournal of cardiothoracic surgery2026
Preoperative levels of biomarkers of coagulation to predict massive bleeding after surgical repair for acute type A aortic dissection: a retrospective cohort study.
Article in Journal of cardiothoracic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAcute type A aortic dissection is a highly emergent condition with a high mortality rate. The condition poses an imminent risk of serious complications such as coagulopathy with massive bleeding. This increases the risk of mortality even after surgical repair. Procoagulant drugs are routinely administered but some patients still suffer postoperative massive bleeding that can be fatal. The study aimed to investigate whether massive bleeding after surgical treatment for type A aortic dissection can be predicted preoperatively through routine coagulation tests such as APTT, PT (INR), fibrinogen, D-dimer, and platelets.
methodsThe study was a retrospective, single-center, cohort study performed at a tertiary cardiac surgery unit. A total of 474 patients who underwent surgery for type A aortic dissection at our department between January 2005 and May 2023 were included in the study. Of these, 87 patients had massive postoperative bleeding after surgery for type A aortic dissection and were compared to 387 patients who did not have massive postoperative bleeding. Uni- and multivariable analyses were performed using logistic regression. The multivariable model included predictors of massive bleeding. Bleeding-related routine lab variables were then forced into the model.
resultsPatients with massive bleeding (18%) had higher preoperative activated partial thromboplastin time (APTT) (33 s vs 29 s, p<0.01), and creatinine (97 µmol/L vs 87 µmol/L, p<0.01), as well as lower preoperative platelet counts (172 × 10
conclusionPreoperative APTT exceeding 34.5 s was independently associated with massive bleeding after type A aortic dissection repair and may, pending prospective validation, help identify patients who could potentially benefit from earlier hemostatic intervention.
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