Impact of false lumen volume on admission coagulopathy in acute type A aortic dissection

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BACKGROUND: Preoperative coagulopathy is frequent in acute type A aortic dissection (ATAAD) and strongly influences bleeding and outcomes. Whether the anatomical burden of the false lumen drives early coagulopathy remains uncertain. METHODS: We conducted a retrospective analysis of consecutive patients undergoing urgent surgery for ATAAD (2019-2023) who had a preoperative blood sample for coagulation assessment and whole-body ECG-gated CT angiography, secondarily used for three-dimensional volumetric analysis of the dissected aorta. Coagulopathy was defined as a prothrombin time ratio (PTr)>1.2. Associations between indexed false lumen volume and coagulation parameters were evaluated, and logistic regression was used to identify independent predictors of coagulopathy. RESULTS: Among the 55 included patients, 16 (29%) presented with coagulopathy at admission. These patients showed reduced levels of coagulation factors II, V, VII, X, and fibrinogen, higher D-dimer concentrations, more frequent shock and malperfusion, and markedly increased risk of major perioperative bleeding (62.5% vs. 20.5%, p = 0.004). Indexed false lumen volume was significantly greater in patients with coagulopathy (162[150-183] vs. 112[68-138] mL/m², p < 0.001) and emerged as an independent predictor of coagulopathy (OR 1.38 per 10 mL/m², 95%CI 1.04-1.96), whereas conventional indices (diameters and length) were not. False lumen volume correlated positively with PTr and negatively with fibrinogen, factor V, factor II, and platelet count. CONCLUSIONS: Indexed false lumen volume independently predicts preoperative coagulopathy in ATAAD and correlates with hemostatic disorders. Three-dimensional volumetric assessment provides a more physiologically relevant anatomical correlate of coagulopathy than traditional two-dimensional indices and could influence perioperative strategies.

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