Preoperative Coagulation Indicators Predict Prolonged Mechanical Ventilation in Acute Type a Aortic Dissection.

BACKGROUND

Preoperative coagulation dysfunction is a common complication among patients with acute type A aortic dissection (ATAAD). However, evidence regarding its association with prolonged mechanical ventilation (PMV) following emergency surgery remains limited.

METHODS

Clinical data from 793 patients with ATAAD were retrospectively collected. Patients were stratified into two groups according to preoperative coagulation function indicators. Logistic regression and nomogram analyses were conducted to assess the relationship between coagulopathy and PMV in patients with ATAAD.

RESULTS

Patients with coagulation dysfunction demonstrated a longer awakening time [9.0 (5.50, 14.0) h versus 7.50 (4.0, 13.0) h, P = 0.015], a higher incidence of PMV [243 (35.5%) versus 28 (25.7%), P = 0.044], a higher incidence of postoperative acute kidney injury (AKI) [382 (55.8%) versus 39 (35.8%), P < 0.001], and a greater requirement for continuous renal replacement therapy (CRRT) [60 (8.8%) versus 3 (2.8%), P = 0.031]. Multivariable logistic regression analysis indicated that PMV was significantly associated with age, duration of surgery, duration of cardiopulmonary bypass (CPB), preoperative lactic acid, creatinine, and fibrin degradation products (FDPs). Subgroup analysis further demonstrated that patients with preoperative FDP levels >15.27 μg/mL experienced poorer early postoperative outcomes.

CONCLUSION

Preoperative coagulopathy was associated with PMV in patients with ATAAD. These findings underscore the clinical relevance of coagulation dysfunction in preoperative risk stratification for ATAAD.