Surgery for Acute Type A Aortic Dissection on Preoperative Anticoagulants and Antiplatelet Agents.

Authors

John J Kelly, Zhe Chen, Nabil Thalji, Bo Zhang, Yu Zhao, William L Patrick, Nicholas J Goel, Chase R Brown, Kendall M Lawrence, Wilson Y Szeto, Joseph E Bavaria, Nimesh D Desai

Published in

The Annals of thoracic surgery. Oct 01, 2026. Epub Oct 01, 2026.

Abstract

Patients taking direct oral anticoagulants (DOACs), warfarin, or dual antiplatelet therapy (DAPT) who present with acute Type A aortic dissection (ATAAD) are a unique challenge. Our objective was to investigate the surgical outcomes of this patient population.
A retrospective cohort study was performed of 20,530 patients who underwent first-time sternotomy repair of ATAAD in the Society of Thoracic Surgeons Adult Cardiac Surgery Database from 2017 to 2022. Propensity score matching was used to pair each DOAC (n=625), warfarin (n=245), and DAPT (n=525) patient with 2 controls. Outcomes included operative mortality and reoperation for bleeding.
Compared to matched controls, mortality was higher for patients on DOACs (24.8% vs 17.9%, OR 1.50 [1.2,2.0], p<0.001), warfarin (26.7% vs 19.2%, OR 1.6 [1.1,2.4], p=0.02), or DAPT (27.4% vs 20.1%, OR 1.5 [1.2,2.0], p=0.001). Reoperation for bleeding was higher for DOACs (12.0% vs 7.0%, OR 1.8 [1.3,2.5], p=0.001) and DAPT (15.2% vs 7.3%, OR 2.2 [1.6,3.2], p<0.001), and trended that way for warfarin (11.4% vs 7.8%, OR 1.5 [0.9,2.6], p=0.11). Most DOAC (76.5% [478/625]) and DAPT (71.2% [374/525]) patients underwent surgery on the day of admission. While there was a non-significant difference toward lower mortality for DOAC patients who had surgery on day ≥1 (17.4% vs 25.0%, p=0.08), there was no difference for those on DAPT.
Patients undergoing first-time surgery for ATAAD on DOACs, DAPT, or warfarin preoperatively had increased mortality and bleeding complications. For those on DOACs or DAPT, further study is required to investigate whether delaying surgery impacts outcomes.

PMID:
42822618
Bibliographic data and abstract were imported from PubMed on 02 Oct 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.