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The condition poses an imminent risk of serious complications such as coagulopathy with massive bleeding. This increases the risk of mortality even after surgical repair. Procoagulant drugs are routinely administered but some patients still suffer postoperative massive bleeding that can be fatal. The study aimed to investigate whether massive bleeding after surgical treatment for type A aortic dissection can be predicted preoperatively through routine coagulation tests such as APTT, PT (INR), fibrinogen, D-dimer, and platelets.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The study was a retrospective, single-center, cohort study performed at a tertiary cardiac surgery unit. A total of 474 patients who underwent surgery for type A aortic dissection at our department between January 2005 and May 2023 were included in the study. Of these, 87 patients had massive postoperative bleeding after surgery for type A aortic dissection and were compared to 387 patients who did not have massive postoperative bleeding. Uni- and multivariable analyses were performed using logistic regression. The multivariable model included predictors of massive bleeding. Bleeding-related routine lab variables were then forced into the model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patients with massive bleeding (18%) had higher preoperative activated partial thromboplastin time (APTT) (33\u00a0s vs 29\u00a0s,\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.01), and creatinine (97\u00a0\u00b5mol\/L vs 87\u00a0\u00b5mol\/L,\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.01), as well as lower preoperative platelet counts (172 \u00d7 10\n                      <jats:sup>9<\/jats:sup>\n                      \/L vs 187 \u00d7 10\n                      <jats:sup>9<\/jats:sup>\n                      \/L,\n                      <jats:italic>p<\/jats:italic>\n                      =0.03) compared to patients without massive bleeding. Patients with massive bleeding also had longer duration of cardiopulmonary bypass (CPB) (221\u00a0min vs 170\u00a0min,\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.01) and suffered more postoperative complications. Multivariable logistic regression identified preoperative APTT per mmol increment (OR 1.04 (95% CI 1.01\u20131.07,\n                      <jats:italic>p<\/jats:italic>\n                      =0.01), preoperative APTT &gt; 34.5\u00a0s (OR 2.95 (95% CI 1.60\u20135.47),\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.01), preoperative creatinine &gt; 82.5\u00a0\u00b5mol\/L (OR 2.16 (95% CI 1.15\u20134.06),\n                      <jats:italic>p<\/jats:italic>\n                      =0.02), hypertension (OR 1.83 (95% CI 1.01\u20133.32),\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.05) and CPB time per 10\u00a0min increment (OR 1.09 (95% CI 1.05\u20131.13,\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.01)) as independent predictors of massive bleeding.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Preoperative APTT exceeding 34.5\u00a0s was independently associated with massive bleeding after type A aortic dissection repair and may, pending prospective validation, help identify patients who could potentially benefit from earlier hemostatic intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13019-026-04692-8","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:42:07Z","timestamp":1791826927000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative levels of biomarkers of coagulation to predict massive bleeding after surgical repair for acute type A aortic dissection: a retrospective cohort study"],"prefix":"10.1186","volume":"21","author":[{"given":"Emilia","family":"Nor\u00e9n","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Ede","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00e5rten","family":"Larsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahab","family":"Nozohoor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan","family":"Sj\u00f6gren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl","family":"Teurneau-Hermansson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"issue":"6","key":"4692_CR1","doi-asserted-by":"publisher","first-page":"1111","DOI":"10.1093\/ejcts\/ezw235","volume":"50","author":"IH Melvinsdottir","year":"2016","unstructured":"Melvinsdottir IH, Lund SH, Agnarsson BA, Sigvaldason K, Gudbjartsson T, Geirsson A. 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Permission to access data was granted by the Institutional Review Board of Sk\u00e5ne University Hospital (ref. 144\u201321).","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"762"}}