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Research Article|Articles in Press

Impact of Antithrombotic Therapy on Clinical Outcomes in Patients with Type B Acute Aortic Syndrome

Open AccessPublished:March 10, 2023DOI:https://doi.org/10.1016/j.xjon.2023.02.017
Impact of Antithrombotic Therapy on Clinical Outcomes in Patients with Type B Acute Aortic Syndrome
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      Abstract

      Objective

      Antithrombotic therapy has the potential to interfere with false lumen thrombosis. In type B acute aortic syndrome (AAS), the degree of false lumen thrombosis affects clinical outcomes. We aimed to assess the impact of antithrombotic therapy on the prognosis of patients with type B AAS.

      Methods

      This single-center study included patients with type B AAS who were discharged alive. The primary outcome was aorta-related adverse events, defined as a composite of aorta-related death, aortic rupture, aortic repair, and progressive aortic dilation.

      Results

      Of the 406 patients, 64 patients (16%) were discharged with antithrombotic therapy and 342 (84%) without antithrombotic therapy. A total of 249 patients (61%) presented with intramural hematoma with complete thrombosis of the false lumen, and 157 (39%) presented with aortic dissection. During a median follow-up of 4.6 years, 32 patients (50%) in the antithrombotic group and 93 patients (27%) in the non-antithrombotic group had a primary outcome event. Cumulative incidence of aorta-related events at 1 and 3 years with death as the competing risk was higher in the antithrombotic group than the non-antithrombotic group (19 ± 5% vs. 9 ± 2% at 1 year and 40 ± 7% vs. 17 ± 2% at 3 years, P < 0.001).

      Conclusion

      Antithrombotic therapy might be associated with an increased risk of aorta-related events in patients with type B AAS.

      Graphical abstract

      Figure thumbnail fx1
      Graphical Abstract

      Key words

      Glossary of abbreviations:

      AAS (acute aortic syndrome), ACE (angiotensin-converting enzyme), AD (aortic dissection), ARB (angiotensin receptor blocker), CAD (coronary artery disease), CCB (calcium channel blocker), COPD (chronic obstructive pulmonary disease), IMH (intramural hematoma), PAD (peripheral artery disease), TEVAR (thoracic endovascular aortic repair)

      Article info

      Publication history

      Accepted: February 28, 2023
      Received: August 20, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      COI: None of the authors have any conflict of interest to declare.

      Competing interests and funding: None

      IRB approval: This study was approved by the institutional review board of the Kobe City Medical Center General Hospital (zn2102222; January 2021).

      Informed consent statement: The need to obtain informed consent was waived because of the retrospective nature of the study.

      Central picture legend: Aorta-related adverse events in patients with and without antithrombotic therapy.

      Central message

      In patients with type B acute aortic syndrome, antithrombotic therapy might be associated with an increased risk of aorta-related events.

      Perspective statement

      Antithrombotic therapy might be associated with an increased risk of aorta-related events in patients with type B acute aortic syndrome. For patients with an indispensable need for antithrombotic therapy, careful follow-up is needed.

      Identification

      DOI: https://doi.org/10.1016/j.xjon.2023.02.017

      Copyright

      © 2023 The Authors. Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery

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