Key result
Preoperative dual antiplatelet therapy before acute type A aortic dissection repair was associated with increased major bleeding (51.3% vs 39.3%; OR 1.63, 95% CI 1.05-2.51) but not 30-day mortality.
Why the study?
Sudden chest pain in acute aortic dissection type A risks misdiagnosis as acute coronary syndrome and subsequent potent antiplatelet treatment, but the impact of preoperative dual antiplatelet therapy on bleeding and mortality required investigation.
Does preoperative dual antiplatelet therapy increase major bleeding and 30-day mortality in patients undergoing surgery for acute aortic dissection type A?
Cohort (n=1,141)
Yes
Does preoperative dual antiplatelet therapy increase major bleeding and 30-day mortality in patients undergoing surgery for acute aortic dissection type A?
Odds Ratio: 1.63 (95% CI 1.05–2.51)
Absolute Event Rate: 51.3% vs 39.3%
p-value: p=0.028
Preoperative DAPT in acute type A aortic dissection increases major bleeding and transfusion requirements but does not significantly impact 30-day mortality, suggesting that ongoing DAPT should not delay life-saving surgery.
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Preoperative DAPT was associated with increased major bleeding but not mortality; leaves open optimal perioperative antiplatelet management in acute type A dissection.
Hansson et al. (2018) conducted a cohort in Acute aortic dissection type A (n=1,141). Dual antiplatelet therapy (DAPT) vs. No DAPT was evaluated on Major bleeding (after propensity score matching) (OR 1.63, 95% CI 1.05-2.51, p=0.028). Preoperative dual antiplatelet therapy before acute type A aortic dissection repair was associated with increased major bleeding (51.3% vs 39.3%; OR 1.63, 95% CI 1.05-2.51) but not 30-day mortality.
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