The Annals of thoracic surgery
October 1, 2026 · via Europe PMC
Surgery for Acute Type A Aortic Dissection on Preoperative Anticoagulants and Antiplatelet Agents.
Kelly JJ, Chen Z, Thalji N, +8 more, Desai ND.
AI summary — for doctors, generated from the abstract only
Patients on DOACs, warfarin, or dual antiplatelet therapy before emergency surgery for acute Type A aortic dissection have significantly higher operative mortality and bleeding complications than those not anticoagulated.
What was studied
Retrospective cohort of 20,530 patients undergoing first-time sternotomy repair for acute Type A aortic dissection (STS database, 2017-2022), with propensity matching of DOAC, warfarin, and DAPT patients to controls.
Key findings
- Mortality was higher for DOAC patients than matched controls (24.8% vs 17.9%, OR 1.50).
- Warfarin and dual antiplatelet therapy patients also had increased mortality and bleeding complications versus controls.
- 625 DOAC, 245 warfarin, and 525 DAPT patients were matched 1:2 to controls from the full 20,530-patient cohort.
Clinical relevance
Cardiac surgeons and intensivists should anticipate higher mortality and bleeding risk and plan reversal or blood product strategies when operating on anticoagulated Type A dissection patients.
Who should care
Limitations
Retrospective registry data cannot fully adjust for why patients were on anticoagulation (indication-related confounding) or for time-to-surgery differences.
Anticipate and proactively manage higher bleeding and mortality risk, including rapid reversal strategies, when performing emergency Type A dissection surgery on anticoagulated or antiplatelet-treated patients.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
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.
Methods
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.
Results
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.
Conclusions
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.
DOI
10.1016/j.athoracsur.2026.08.029
PMID
42822618
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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