Risk factors for coagulopathy after Stanford type A acute aortic dissection repair
10.7507/1007-4848.201712021
- VernacularTitle:急性 Stanford A 型主动脉夹层术后凝血功能障碍危险因素分析
- Author:
LI Shuwen
1
;
YANG Yanwei
1
;
LU Jiakai
1
;
CHENG Weiping
1
;
JIN Mu
2
,
3
Author Information
1. Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Disease, Capital Medical University, Beijing, 100029, P.R.China
2. 1. Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Disease, Capital Medical University, Beijing, 100029, P.R.China
3. 2. Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100069, P.R.China
- Publication Type:Journal Article
- Keywords:
Aortic dissection;
surgery;
coagulopathy
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2018;25(8):670-675
- CountryChina
- Language:Chinese
-
Abstract:
Objective To identify the risk factors for coagulopathy after Stanford type A acute aortic dissection (AAD) repair to offer evidence for improvement of patients' prognosis. Methods We retrospectively analyzed the clinical data of 95 patients undergoing Stanford type A AAD repair in Beijing Anzhen Hospital between January 2013 and December 2014. Patients with thromboelastography-coagulation index (TEG-CI) ≤–3 after surgery were allocated to a coagulopathy group (n=17, average age 48.70 years), whereas patients with TEG-CI >–3 after surgery were allocated to a control group (n=78, average age 46.80 years). Multivariate analysis was used to identify risk factors for coagulopathy after surgery. Results Seventeen patients suffered from coagulopathy after surgery. Patients in the coagulopathy group had larger amount of fluid drainage than that in the control group (P=0.008). Risk factors for postoperative coagulopathy were activated partial thromboplastin time (APTT) at the end of surgery ( OR=0.011, 95% confidence interval 0.001 to 0.021, P=0.035), fibrinogen degradation products (FDP) at the end of surgery (OR=0.004, 95% confidence interval 0.001 to 0.007, P=0.022) and platelet count (×109/L) at the end of surgery (OR=–0.002, 95% confidence interval –0.003 to 0.000, P=0.049). The lower risk of postoperative coagulopathy was related to the platelet count at the end of surgery up to 137.00 × 109/L. Conclusion Postoperative coagulopathy could be related to the clinical and experimental variables. In a representative sample of Chinese adults undergoing Stanford type A AAD surgery, APTT, FDP and platelet count at the end of surgery are independent risk factors associated with postoperative coagulopathy. Adding haemostatic, such as fibrinogen and prothrombinase complex, is good for improving the recovery of coagulation function to reduce bleeding and postoperative blood transfusion, as well as adding platelet, plasma and other coagulation factors after AAD surgery.
