title: Outcome After Surgery for Acute Aortic Dissection: Influence of Preoperative Antiplatelet Therapy on Prognosis.
abstract: OBJECTIVE
  Outcome in patients with acute coronary syndrome (ACS) is improved with dual antiplatelet therapy (DAPT). Patients with acute aortic dissection type A (AAD) often present with similar symptoms and may therefore be prescribed DAPT before diagnosis. The aim of this study was to evaluate the use of antiplatelet therapy (APT) prior to AAD surgery and patient outcome, including indications according to the European Society of Cardiology's (ESC) recent guidelines.
  
  
  METHODS
  A retrospective, observational study.
  
  
  METHODS
  A tertiary University Hospital, Rigshospitalet, Heart Centre, Copenhagen, Denmark.
  
  
  METHODS
  The study included 171 patients operated for AAD during 2010 to 2014.
  
  
  METHODS
  The independent relationship of preoperative APT was explored on 30-day mortality, intraoperative bleeding and perioperative transfusion requirements. Furthermore, the indications for APT were obtained.
  
  
  RESULTS
  Patients receiving APT (n = 73) did not have an increased 30-day mortality (29% v 20%, p = 0.18). However, APT increased intraoperative bleeding by 45% (p<0.001) and increased perioperative transfusion of red blood cells by 71%, fresh frozen plasma by 52%, and platelets by 56% (p = 0.002). Among patients receiving APT preoperatively, 26 patients received acetylsalicylic acid (ASA) alone and 46 patients received DAPT. Bleeding was significantly more pronounced in patients receiving DAPT (5.6±4.1 L), compared to ASA alone (3.6±3.1 L) and no APT (3.3±4.8 L) (p<0.001). However, there was no significant difference in mortality between groups. DAPT, including ticagrelor, increased intraoperative bleeding by 62% compared to DAPT with clopidogrel (p = 0.004). Among patients receiving DAPT, only 30% of the patients fulfilled ESC criteria for ACS treatment.
  
  
  CONCLUSIONS
  The use of APT was associated with increased intraoperative bleeding and transfusion requirement; however, it was not associated with a statistically significant increased mortality. Only a minority of patients fulfilled ESC criteria for ACS treatment with DAPT.
authors.affiliation: Department of Cardiothoracic Anaesthesiology, Rigshospitalet, Copenhagen, Denmark. Electronic address: hanne.berg.ravn@regionh.dk.
authors.forename: Raphaelle Avigael
authors.initials: RA
authors.lastname: Chemtob
authors.affiliation: Department of Cardiothoracic Anaesthesiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Hasse
authors.initials: H
authors.lastname: Moeller-Soerensen
authors.affiliation: Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Lene
authors.initials: L
authors.lastname: Holmvang
authors.affiliation: Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Peter Skov
authors.initials: PS
authors.lastname: Olsen
authors.affiliation: Department of Cardiothoracic Anaesthesiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Hanne Berg
authors.initials: HB
authors.lastname: Ravn
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D011183:Postoperative Complications / Q000139:chemically induced* / Q000175:diagnosis; D011300:Preoperative Care / Q000009:adverse effects* / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: acute coronary syndromes; antiplatelet therapy; aortic dissection; aortic surgery; bleeding; outcome