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Preoperative dual a...
Preoperative dual antiplatelet therapy increases bleeding and transfusions but not mortality in acute aortic dissection type A repair.
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- Hansson, Emma C., 1985 (author)
- University of Gothenburg,Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine
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- Geirsson, Arnar (author)
- Yale University
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- Hjortdal, Vibeke (author)
- Aarhus University Hospital Skejby
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- Mennander, Ari (author)
- University of Tampere
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- Olsson, Christian (author)
- Karolinska Institutet
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- Gunn, Jarmo (author)
- University of Turku
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- Zindovic, Igor (author)
- Lund University,Lunds universitet,Thoraxkirurgi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Minimalinvasiv hjärtkirurgi vid hjärtklaffsjukdom,Forskargrupper vid Lunds universitet,Blödningsrubbningar och akut typ-A dissektion,Thoracic Surgery,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Minimal invasive cardiac surgery in valvular heart disease,Lund University Research Groups,Bleeding disorders and acute typ-A dissection,Skåne University Hospital
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- Ahlsson, Anders (author)
- Karolinska Institutet,Karolinska Institute,Copenhagen University Hospital
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- Nozohoor, Shahab (author)
- Lund University,Lunds universitet,Thoraxkirurgi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Minimalinvasiv hjärtkirurgi vid hjärtklaffsjukdom,Forskargrupper vid Lunds universitet,Blödningsrubbningar och akut typ-A dissektion,Thoracic Surgery,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Minimal invasive cardiac surgery in valvular heart disease,Lund University Research Groups,Bleeding disorders and acute typ-A dissection,Skåne University Hospital
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Chemtob, Raphaelle A (author)
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- Pivodic, Aldina (author)
- Statistiska Konsultgruppen
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- Gudbjartsson, Tomas (author)
- University of Iceland
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- Jeppsson, Anders, 1960 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine,Sahlgrenska University Hospital
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(creator_code:org_t)
- 2019-01-16
- 2019
- English.
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In: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. - : Oxford University Press (OUP). - 1873-734X .- 1010-7940. ; 56:1, s. 182-188
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http://dx.doi.org/10...
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Abstract
Subject headings
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- Acute aortic dissection type A is a life-threatening condition, warranting immediate surgery. Presentation with sudden chest pain confers a risk of misdiagnosis as acute coronary syndrome resulting in subsequent potent antiplatelet treatment. We investigated the impact of dual antiplatelet therapy (DAPT) on bleeding and mortality using the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) database.The NORCAAD database is a retrospective multicentre database where 119 of 1141 patients (10.4%) had DAPT with ASA+clopidogrel (n=108) or ASA+ticagrelor (n=11) before surgery. The incidence of major bleeding and 30-day mortality was compared between DAPT and non-DAPT patients with logistic regression models before and after propensity score matching.Before matching, 51.3% of DAPT patients had major bleeding when compared to 37.7% of non-DAPT patients (P=0.0049). DAPT patients received more transfusions of red blood cells [median 8U (Q1-Q3 4-15) vs 5.5U (2-11), P<0.0001] and platelets [4U (2-8) vs 2U (1-4), P=0.0001]. Crude 30-day mortality was 19.3% vs 17.0% (P=0.60). After matching, major bleeding remained significantly more common in DAPT patients, 51.3% vs 39.3% [odds ratio (OR) 1.63, 95% confidence interval (CI) 1.05-2.51; P=0.028], but mortality did not significantly differ (OR 0.88, 95% CI 0.51-1.50; P=0.63). Major bleeding was associated with increased 30-day mortality (adjusted OR 2.44, 95% CI 1.72-3.46; P<0.0001).DAPT prior to acute aortic dissection repair was associated with increased bleeding and transfusions but not with mortality. Major bleeding per se was associated with a significantly increased mortality. Correct diagnosis is important to avoid DAPT and thereby reduce bleeding risk, but ongoing DAPT should not delay surgery.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Keyword
- Acute aortic dissection
- Antiplatelet agents
- Bleeding complications
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Hansson, Emma C. ...
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Geirsson, Arnar
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Hjortdal, Vibeke
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Mennander, Ari
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Olsson, Christia ...
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Gunn, Jarmo
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show more...
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Zindovic, Igor
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Ahlsson, Anders
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Nozohoor, Shahab
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Chemtob, Raphael ...
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Pivodic, Aldina
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Gudbjartsson, To ...
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Jeppsson, Anders ...
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cardiac and Card ...
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European journal ...
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European Journal ...
- By the university
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University of Gothenburg
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Lund University
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Karolinska Institutet