{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T08:49:10Z","timestamp":1794473350455,"version":"4.9.1"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2021,8,30]],"date-time":"2021-08-30T00:00:00Z","timestamp":1630281600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Beijing Major Science and Technology Projects from the Beijing Municipal Science and Technology Commission","award":["Z171100001017083"],"award-info":[{"award-number":["Z171100001017083"]}]},{"name":"Beijing Major Science and Technology Projects from the Beijing Municipal Science and Technology Commission","award":["Z191100006619093"],"award-info":[{"award-number":["Z191100006619093"]}]},{"name":"Beijing Major Science and Technology Projects from the Beijing Municipal Science and Technology Commission","award":["Z191100006619094"],"award-info":[{"award-number":["Z191100006619094"]}]},{"name":"National Science and Technology Support Program","award":["2015BAI12B03"],"award-info":[{"award-number":["2015BAI12B03"]}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81970393"],"award-info":[{"award-number":["81970393"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,1,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>OBJECTIVES<\/jats:title><jats:p>Data are scarce and mixed regarding the impact of preoperative dual antiplatelet therapy (DAPT) on the surgical outcomes of acute type A aortic dissection (ATAAD). We seek to evaluate the impact of DAPT on bleeding-related events and early- and mid-term mortality after total arch replacement and frozen elephant trunk in such patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>This study comprised 48 ATAAD patients on preoperative DAPT and 418 without DAPT (the whole series, i.e. unmatched cohort), from which 45 matched pairs were selected by propensity score (matched cohort). Bleeding-related events (reoperation for bleeding, bleeding of \u22651500\u2009ml within the first 12\u2009h postoperatively or transfusion of \u226510 units of red blood cell or use of recombinant activated factor VII), operative mortality and mid-term survival were compared in the unmatched and matched cohorts. The impact of preoperative DAPT was evaluated with multivariable analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>In the unmatched cohort, bleeding of \u22651500\u2009ml\/12 h postoperatively was more common in the DAPT group (18.8% vs 8.4%, P\u2009=\u20090.020); operative mortality was 9.7%, which did not differ with DAPT (12.5% vs 9.3%, P\u2009=\u20090.48). Nor did bleeding-related events (54.2% vs 43.5%, P\u2009=\u20090.16) differ significantly between 2 groups. In the matched cohort, neither were drainage of \u22651500\u2009ml\/12 h (20% vs 6.7%, P\u2009=\u20090.063) and bleeding-related events (53.3% vs 42.2%, P\u2009=\u20090.30), nor operative mortality (13.8 vs 8.9%, P\u2009=\u20090.50) and mid-term survival (79.3% vs 76.4%, P\u2009=\u20090.93) significantly different between 2 groups. DAPT was not identified as a predictor for operative mortality [odd ratio (OR) 0.97, 95% confidence interval (CI) 0.31\u20133.08; P\u2009=\u20090.96; adjusted OR 1.28, 95% CI 0.22\u20137.20; P\u2009=\u20090.78] and bleeding-related events (OR 1.50, 95% CI 0.76\u20132.95; P\u2009=\u20090.24; adjusted OR 2.03, 95% CI 0.80\u20133.66; P\u2009=\u20090.14).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>In patients with ATAAD undergoing total arch replacement and frozen elephant trunk, although preoperative DAPT led to more postoperative bleeding, it did not increase bleeding-related events nor operative mortality nor mid-term death. The results of this study imply that for patients with ATAAD, emergency surgical repair, even if as extensive as total arch repair, should not be contraindicated or delayed simply because of ongoing DAPT.<\/jats:p><\/jats:sec>","DOI":"10.1093\/icvts\/ivab226","type":"journal-article","created":{"date-parts":[[2021,7,24]],"date-time":"2021-07-24T03:17:35Z","timestamp":1627096655000},"page":"120-127","source":"Crossref","is-referenced-by-count":11,"title":["Does preoperative dual antiplatelet therapy affect bleeding and mortality after total arch repair for acute type A dissection?"],"prefix":"10.1093","volume":"34","author":[{"given":"Fu-Cheng","family":"Xiao","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases , Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3873-0837","authenticated-orcid":false,"given":"Wei-Guo","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases , Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Pen","family":"Ge","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases , Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun-Ming","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases , Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9750-5854","authenticated-orcid":false,"given":"Li-Zhong","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases , Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,8,30]]},"reference":[{"key":"2023032218574466400_","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1378\/chest.117.5.1271","article-title":"Epidemiology and clinicopathology of aortic dissection","volume":"117","author":"M\u00e9sz\u00e1ros","year":"2000","journal-title":"Chest"},{"key":"2023032218574466400_","doi-asserted-by":"crossref","first-page":"2779","DOI":"10.1093\/eurheartj\/ehv178","article-title":"2014 ESC Guidelines on the diagnosis and treatment of aortic diseases","volume":"36","author":"Erbel","year":"2015","journal-title":"Eur Heart J"},{"key":"2023032218574466400_","doi-asserted-by":"crossref","first-page":"e266\u2013369","DOI":"10.1161\/CIR.0b013e3181d47d48","article-title":"2010 ACCF\/AHA\/AATS\/ACR\/ASA\/SCA\/SCAI\/SIR\/STS\/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease","volume":"121","author":"Hiratzka","year":"2010","journal-title":"Circulation"},{"key":"2023032218574466400_","first-page":"201","article-title":"Hematological consequences of profound hypothermic circulatory arrest and aortic dissection","volume":"12","author":"Wilde","year":"1997","journal-title":"J Card Surg"},{"key":"2023032218574466400_","first-page":"246","article-title":"Coagulation disturbance in profound hypothermia: the influence of anti-fibrinolytic therapy","volume":"9","author":"Westaby","year":"1997","journal-title":"Semin Thorac Cardiovasc Surg"},{"key":"2023032218574466400_","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/S0735-1097(02)01954-X","article-title":"The effect of clopidogrel in combination with aspirin when given before coronary artery bypass grafting","volume":"40","author":"Hongo","year":"2002","journal-title":"J Am Coll Cardiol"},{"key":"2023032218574466400_","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1016\/j.ejcts.2009.05.032","article-title":"Postoperative blood loss in patients undergoing coronary artery bypass surgery after preoperative treatment with clopidogrel. 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