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Background <p>Acute type A aortic dissection (ATAAD) is a surgical emergency, yet misdiagnosis as acute coronary syndrome (ACS) frequently leads to preoperative administration of antiplatelet therapy (APT). The impact of APT on perioperative outcomes in ATAAD remains controversial, with conflicting evidence regarding its effects on transfusion requirements, complication rates, and mortality. Our meta-analysis aims to clarify the influence of preoperative APT on surgical and postoperative outcomes in ATAAD.</p> Methods <p>A thorough literature search was conducted to identify studies comparing perioperative outcomes in ATAAD patients with and without preoperative APT. Pooled odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using RevMan 8.13.0, with heterogeneity assessed via the <i>I</i><sup>2</sup> statistic. Subgroup analyses restricted to propensity-matched studies (PMS) and patients receiving dual antiplatelet therapy (DAPT) were also conducted.</p> Results <p>We included five studies comprising 2,789 patients, of whom 361 (13.0%) received preoperative APT. APT was associated with increased transfusion requirements, including red blood cells [MD 2.1 units; 95% CI 0.2–4.0; <i>p</i> = 0.03; <i>I</i><sup>2</sup> = 74%], platelets [MD 1.6 units; 95% CI 0.2–2.9; <i>p</i> = 0.03; <i>I</i><sup>2</sup> = 90%], and rFVIIa use [OR 1.2; 95% CI 1.2–2.8; <i>p</i> = 0.008; <i>I</i><sup>2</sup> = 0%]. In the PMS-only subgroup, rFVIIa use remained significantly higher in the APT group [OR 1.8; 95% CI 1.2–2.9; <i>p</i> = 0.008; <i>I</i><sup>2</sup> = 0%]. Similarly, in the DAPT subgroup, higher RBC transfusion [MD 1.8 units; 95% CI 0.5–3.2; <i>p</i> = 0.009] and rFVIIa use [MD 2.0 units; 95% CI 1.2–3.3; <i>p</i> = 0.01] were observed. However, 30-day mortality, postoperative complications, including reoperation and stroke, and recovery metrics, including ICU stay and mechanical ventilation duration, did not differ significantly between groups.</p> Conclusions <p>While APT was associated with greater transfusion requirements, it did not translate into higher mortality, reoperation rates, or major postoperative complications. Our findings reinforce that APT should not delay life-saving surgery. Instead, the focus should shift toward proactive haemostatic support, not deferral of definitive repair. However, these results should be interpreted with caution due to potential confounding and heterogeneity in surgical practices, APT regimens, and transfusion protocols.</p> <p>Trial registration.</p> <p>PROSPERO CRD420250654320.</p>

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Does preoperative antiplatelet therapy worsen outcomes in acute type A aortic dissection surgery? A meta-analytic review

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月25日

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  • Kristine Santos,
  • Eren Cetinel,
  • Joo Young Belen Kim Kim,
  • Jose Manuel Comprido,
  • Khaled Alhwaishel,
  • Amrinder Kaur,
  • Tomasz Płonek

摘要

Background

Acute type A aortic dissection (ATAAD) is a surgical emergency, yet misdiagnosis as acute coronary syndrome (ACS) frequently leads to preoperative administration of antiplatelet therapy (APT). The impact of APT on perioperative outcomes in ATAAD remains controversial, with conflicting evidence regarding its effects on transfusion requirements, complication rates, and mortality. Our meta-analysis aims to clarify the influence of preoperative APT on surgical and postoperative outcomes in ATAAD.

Methods

A thorough literature search was conducted to identify studies comparing perioperative outcomes in ATAAD patients with and without preoperative APT. Pooled odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using RevMan 8.13.0, with heterogeneity assessed via the I2 statistic. Subgroup analyses restricted to propensity-matched studies (PMS) and patients receiving dual antiplatelet therapy (DAPT) were also conducted.

Results

We included five studies comprising 2,789 patients, of whom 361 (13.0%) received preoperative APT. APT was associated with increased transfusion requirements, including red blood cells [MD 2.1 units; 95% CI 0.2–4.0; p = 0.03; I2 = 74%], platelets [MD 1.6 units; 95% CI 0.2–2.9; p = 0.03; I2 = 90%], and rFVIIa use [OR 1.2; 95% CI 1.2–2.8; p = 0.008; I2 = 0%]. In the PMS-only subgroup, rFVIIa use remained significantly higher in the APT group [OR 1.8; 95% CI 1.2–2.9; p = 0.008; I2 = 0%]. Similarly, in the DAPT subgroup, higher RBC transfusion [MD 1.8 units; 95% CI 0.5–3.2; p = 0.009] and rFVIIa use [MD 2.0 units; 95% CI 1.2–3.3; p = 0.01] were observed. However, 30-day mortality, postoperative complications, including reoperation and stroke, and recovery metrics, including ICU stay and mechanical ventilation duration, did not differ significantly between groups.

Conclusions

While APT was associated with greater transfusion requirements, it did not translate into higher mortality, reoperation rates, or major postoperative complications. Our findings reinforce that APT should not delay life-saving surgery. Instead, the focus should shift toward proactive haemostatic support, not deferral of definitive repair. However, these results should be interpreted with caution due to potential confounding and heterogeneity in surgical practices, APT regimens, and transfusion protocols.

Trial registration.

PROSPERO CRD420250654320.