Impact of Coagulopathy at Admission on Perioperative Blood Transfusion in Acute Type A Aortic Dissection

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Introduction Surgery for acute type A aortic dissection (ATAAD) may expose patients to major bleeding and massive transfusion. We assessed the impact of coagulopathy upon admission, before surgery, on perioperative transfusion requirements and clinical outcomes. Methods We conducted a retrospective single-center study including consecutive patients undergoing emergency surgical aortic repair for ATAAD from August 2017 to July 2022 in a tertiary referral center. We assessed the association between coagulopathy at hospital admission, defined by an International Normalized Ratio (INR) >1.2, and perioperative transfusion requirements and clinical outcomes. Results Among 133 included patients operated for ATAAD, 36 (27%) had coagulopathy at admission. Compared with non-coagulopathic patients, they more frequently presented with preoperative shock and had higher lactate levels at admission. Coagulopathic patients received more intraoperative red blood cell (RBC) transfusions (4 [1.7-7] vs 2 [0-4] units, p=0.009), fresh frozen plasma (FFP) (4 [2.8-6] vs 3 [2-4] units, p=0.028), platelets (5.3 [3.7-8.2] vs 4 [3.2-5.5] x10 11 platelets, p=0.033), and fibrinogen concentrates (3 [2-3.3] vs 2 [1.5-3] g, p=0.019). They also required more RBC transfusion within 48 hours after surgery (5 [3-7] vs 3 [1-4] units, p=0.002) (primary endpoint). ROC analysis showed that INR >1.2 had moderate discriminative ability for predicting intraoperative transfusion of ≥3 RBC units (AUROC 0.68), with high specificity (84%) but limited sensitivity (36%). Postoperative complications were frequent and comparable between groups. Finally, in-hospital mortality rate was 25% in the coagulopathy group versus 16.5% in the group without coagulopathy. Conclusion Admission coagulopathy in ATAAD was associated with increased perioperative transfusion requirements. Preoperative INR may contribute to early transfusion risk assessment, although its limited sensitivity precludes its use as a standalone predictive tool.

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