A prospective, controlled study on the utility of rotational
thromboelastometry in surgery for acute type A aortic dissection
Abstract
Objective: To evaluate the hemostatic system with ROTEM in
patients undergoing surgery for acute type aortic dissection (ATAAD)
using elective aortic procedures as controls. Design: This was
a prospective, controlled, observational study. Setting: The
study was performed at a tertiary referral center and university
hospital. Participants: Twenty-three patients with ATAAD were
compared to 20 control patients undergoing elective surgery of the
ascending aorta or the aortic root. Results: ROTEM (INTEM,
EXTEM, HEPTEM and FIBTEM) was tested at 6 points in time before, during
and after surgery for ATAAD or elective aortic surgery. The ATAAD group
had an activated coagulation coming into the surgical theatre. The two
groups showed activation of both major coagulation pathways during
surgery, but the ATAAD group consistently had larger deficiencies.
Reversal of the coagulopathy was successful, although none of the groups
reached elective baseline until postoperative day 1. ROTEM did not
detect low levels of clotting factors at heparin reversal nor low levels
of platelets. Conclusions: This study demonstrated that ATAAD
is associated with a coagulopathic state. Surgery causes additional
damage to the hemostatic system in ATAAD patients as well as in patients
undergoing elective surgery of the ascending aorta or the aortic root.
ROTEM does not adequately catch the full coagulopathy in ATAAD. A
transfusion protocol in ATAAD should be specifically created to target
this complex coagulopathic state and ROTEM does not negate the need for
routine laboratory tests.