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

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.