Objective

The study objective was to analyze the effects of chronic oral anticoagulation on long-term outcomes after repair of type A acute aortic dissection and its influence on false lumen fate.

Methods

We studied 188 patients (median age, 62 years; 74% were male) who underwent repair of type A aortic dissection; patients receiving postoperative chronic oral anticoagulation (n = 59) were compared with those receiving antiplatelet therapy alone (n = 129).

Results

Median age was similar: 60 years (18-79 years; OAC group) versus 64 years (22-86; no-OAC group) (P = .11); patients taking anticoagulants were more frequently male (88% vs 67%, P = .003). After a median follow-up of 8.4 years (2 months to 30 years), 58 patients died, 18 of aortic-related causes, and 37 patients underwent aortic reintervention. After multivariable adjustment, anticoagulation showed no significant effect on long-term survival (hazard ratio, 0.85; 95% confidence interval, 0.41-1.76; P = .66) or risk of reintervention (hazard ratio, 0.55; 95% confidence interval, 0.27-1.15; P = .11). Analysis of 127 postoperative computed tomography scans showed a patent false lumen in 53% of anticoagulated patients versus 38% of nonanticoagulated patients (P = .09): partially thrombosed in 8% versus 28% (P = .01) and thrombosed in 39% versus 34% (P = .63), respectively. In patients with a control computed tomography, there were 6 late aortic-related deaths, 1 among anticoagulated patients and 5 in those who were not.

Conclusions

Chronic anticoagulation after repair of type A acute aortic dissection favors persistent late false lumen patency, which is not a risk factor for late mortality or reoperation. Chronic anticoagulation can be administered safely to patients with repaired type A acute aortic dissection regardless of its specific indication.

中文翻译：

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口服抗凝剂会影响急性 A 型主动脉夹层修复术后的结果和假腔通畅吗？

客观的

研究目的是分析慢性口服抗凝药对 A 型急性主动脉夹层修复术后远期结局的影响及其对假腔命运的影响。

方法

我们研究了 188 名接受 A 型主动脉夹层修复术的患者（中位年龄 62 岁；74% 为男性）；接受术后慢性口服抗凝治疗的患者 (n = 59) 与接受单独抗血小板治疗的患者 (n = 129) 进行了比较。

结果

中位年龄相似：60 岁（18-79 岁；OAC 组）与 64 岁（22-86 岁；无 OAC 组）（P  = .11）；服用抗凝血剂的患者更多是男性（88% 对 67%，P  = .003）。在中位随访 8.4 年（2 个月至 30 年）后，58 名患者死亡，其中 18 名死于主动脉相关原因，37 名患者接受了主动脉再介入治疗。多变量调整后，抗凝治疗对长期生存（风险比 0.85；95% 置信区间 0.41-1.76；P  = .66）或再干预风险（风险比 0.55；95% 置信区间 0.27）没有显着影响-1.15；P = .11). 对 127 例术后计算机断层扫描的分析显示，53% 的抗凝患者和 38% 的非抗凝患者存在明显的假腔 ( P  = .09)：8% 对 28% ( P  = .01) 部分血栓形成，39% 血栓形成分别为 34% ( P  = .63)。在进行对照计算机断层扫描的患者中，有 6 例晚期主动脉相关死亡，其中 1 例发生在接受抗凝治疗的患者中，5 例发生在未接受抗凝治疗的患者中。

结论

A 型急性主动脉夹层修复后的慢性抗凝有利于持续的晚期假腔通畅，这不是晚期死亡或再次手术的危险因素。慢性抗凝治疗可以安全地用于 A 型急性主动脉夹层修复术后的患者，无论其具体指征如何。