Study Design
This was a prospective, single center, observational study comparing
patients undergoing surgery for ATAAD with a control group consisting of
patients undergoing elective aortic surgery of the ascending aorta
and/or the aortic root. The ATAAD group consisted of patients over the
age of 18 with symptom duration <48h undergoing surgery for
ATAAD at Skåne University Hospital, Lund, Sweden, between September 2015
and April 2018. ATAAD was confirmed by contrast-enhanced computed
tomography. The anatomical extent of the dissection was defined
according to the Stanford 18 and Debakey19 classification. Exclusion criteria were
preoperative use of
anti-coagulants
or anti-platelet drugs other than aspirin (both groups) and if surgical
approach deviated from routine (as described below) (ATAAD group).
All patients with acute aortic syndromes (e.g. ATAAD and
intramural hematomas) referred to our clinic during the study period
were registered and screened for inclusion (Fig 1). Routinely, a ROTEM
Delta (Tem Innovations GmgH, Germany) and standard lab test guided
bleeding management protocol was used at our clinic (Fig 2). Red blood
cell transfusions were given at B-Hemoglobin <90g/L. Platelets
were administered at maximum clot firmness (MCF) EXTEM <50mm
and MCF FIBTEM >10mm or platelet count
<100x109/L. Fibrinogen and/or plasma were
used at MCF FIBTEM <15mm or P-fibrinogen <2g/l.
Plasma or prothrombin complex concentrate (PCC) were used at coagulation
time (CT) EXTEM >100s, CT INTEM >240s,
P-PT(INR) >1.5 or P-APTT >1.5 x normal value.
Additional Tranexamic acid was used when maximum lysis (ML) exceeded
15%. However, final decision regarding transfusions was at the
surgeon’s discretion.