The Impact of Intra-Operative Heparin on Thromboembolism and Death in a Matched Cohort of Patients with a Ruptured Abdominal Aortic Aneurysm

Detalhes bibliográficos
Autor(a) principal: Ribeiro, Tiago F
Data de Publicação: 2024
Outros Autores: Correia, Ricardo, Soares Ferreira, Rita, Bastos Gonçalves, Frederico, Amaral, Carlos, Ferreira, Maria Emília
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://hdl.handle.net/10362/162423
Resumo: Publisher Copyright: © 2023 The Author(s)
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spelling The Impact of Intra-Operative Heparin on Thromboembolism and Death in a Matched Cohort of Patients with a Ruptured Abdominal Aortic AneurysmAbdominal aortic aneurysmEvent free survivalRuptured aortic aneurysmsThromboembolismUnfractionated heparinSurgeryCardiology and Cardiovascular MedicinePublisher Copyright: © 2023 The Author(s)Objective: Portuguese nationwide estimates indicate that 20% of abdominal aortic aneurysms (AAAs) are treated when ruptured. In these cases, intra-operative unfractionated heparin (UFH) usage rates vary widely. Evidence on this topic is scarce and focused on patients treated by open repair (OSR). The aim was to determine the influence of UFH on peri-operative thromboembolic events (TEs) and death in a cohort of ruptured AAA (rAAA). Methods: Retrospective, single-centre, comparative study. From 2011 to April 2023, all consecutive rAAAs (endovascular repair [EVAR] and OSR) were considered. Primary outcomes were 30-day TE free survival and TE rates. The secondary outcome was 30-day death. Safety endpoints were procedural blood loss, blood product requirements, and secondary interventions due to haemorrhage. Using propensity score matching (PSM) each UFH patient was matched with one no UFH patient in a 1:1 ratio. Results: The study included 250 patients. After PSM, 190 patients were analysed (EVAR: 60.0% no-UFH vs. 64.4% UFH). TE free survival estimates favoured the UFH group (67.3% vs. 47.2%, p = .009; UFH adjusted odds ratio [aOR] 2.01, 95% confidence interval [CI] 1.04–4.17). TEs were more frequent in the no UFH group (20.0% vs. 44.2% patients, p < .001; UFH aOR 0.31, 95% CI 0.15–0.65 for any TE), driven by an increase in bowel ischaemia (17.9% no UFH vs. 3.2% UFH, p = .001). Most events occurred in the first 72 hours. EVAR was associated with reduced TE and improved TE free survival (aOR 0.20, 95% CI 0.09–0.45 and aOR 5.54, 95% CI 2.34–13.08, respectively). No significant differences in 30-day survival were noted (75% no-UFH vs. 83% UFH, p = .26; aOR 1.08, 95% CI 0.48–2.43) nor in blood loss, peri-operative red blood cell and fresh frozen plasma requirements, or secondary interventions due to haemorrhage (p = .10; p = .11; p = .13 and p = .18 respectively). Conclusion: In this cohort, intra-operative UFH was safe and associated with improved TE free survival, driven by a reduction in bowel ischaemia. Conversely, mortality remained unaffected. Randomised controlled trials are required to confirm these findings.NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)RUNRibeiro, Tiago FCorreia, RicardoSoares Ferreira, RitaBastos Gonçalves, FredericoAmaral, CarlosFerreira, Maria Emília2024-01-17T22:36:59Z2024-012024-01-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article7application/pdfhttp://hdl.handle.net/10362/162423eng2666-688XPURE: 81487102https://doi.org/10.1016/j.ejvsvf.2023.11.004info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2024-03-11T05:45:21Zoai:run.unl.pt:10362/162423Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T03:58:54.126338Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv The Impact of Intra-Operative Heparin on Thromboembolism and Death in a Matched Cohort of Patients with a Ruptured Abdominal Aortic Aneurysm
title The Impact of Intra-Operative Heparin on Thromboembolism and Death in a Matched Cohort of Patients with a Ruptured Abdominal Aortic Aneurysm
spellingShingle The Impact of Intra-Operative Heparin on Thromboembolism and Death in a Matched Cohort of Patients with a Ruptured Abdominal Aortic Aneurysm
Ribeiro, Tiago F
Abdominal aortic aneurysm
Event free survival
Ruptured aortic aneurysms
Thromboembolism
Unfractionated heparin
Surgery
Cardiology and Cardiovascular Medicine
title_short The Impact of Intra-Operative Heparin on Thromboembolism and Death in a Matched Cohort of Patients with a Ruptured Abdominal Aortic Aneurysm
title_full The Impact of Intra-Operative Heparin on Thromboembolism and Death in a Matched Cohort of Patients with a Ruptured Abdominal Aortic Aneurysm
title_fullStr The Impact of Intra-Operative Heparin on Thromboembolism and Death in a Matched Cohort of Patients with a Ruptured Abdominal Aortic Aneurysm
title_full_unstemmed The Impact of Intra-Operative Heparin on Thromboembolism and Death in a Matched Cohort of Patients with a Ruptured Abdominal Aortic Aneurysm
title_sort The Impact of Intra-Operative Heparin on Thromboembolism and Death in a Matched Cohort of Patients with a Ruptured Abdominal Aortic Aneurysm
author Ribeiro, Tiago F
author_facet Ribeiro, Tiago F
Correia, Ricardo
Soares Ferreira, Rita
Bastos Gonçalves, Frederico
Amaral, Carlos
Ferreira, Maria Emília
author_role author
author2 Correia, Ricardo
Soares Ferreira, Rita
Bastos Gonçalves, Frederico
Amaral, Carlos
Ferreira, Maria Emília
author2_role author
author
author
author
author
dc.contributor.none.fl_str_mv NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
RUN
dc.contributor.author.fl_str_mv Ribeiro, Tiago F
Correia, Ricardo
Soares Ferreira, Rita
Bastos Gonçalves, Frederico
Amaral, Carlos
Ferreira, Maria Emília
dc.subject.por.fl_str_mv Abdominal aortic aneurysm
Event free survival
Ruptured aortic aneurysms
Thromboembolism
Unfractionated heparin
Surgery
Cardiology and Cardiovascular Medicine
topic Abdominal aortic aneurysm
Event free survival
Ruptured aortic aneurysms
Thromboembolism
Unfractionated heparin
Surgery
Cardiology and Cardiovascular Medicine
description Publisher Copyright: © 2023 The Author(s)
publishDate 2024
dc.date.none.fl_str_mv 2024-01-17T22:36:59Z
2024-01
2024-01-01T00:00:00Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
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status_str publishedVersion
dc.identifier.uri.fl_str_mv http://hdl.handle.net/10362/162423
url http://hdl.handle.net/10362/162423
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv 2666-688X
PURE: 81487102
https://doi.org/10.1016/j.ejvsvf.2023.11.004
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
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application/pdf
dc.source.none.fl_str_mv reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron:RCAAP
instname_str Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron_str RCAAP
institution RCAAP
reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
collection Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
repository.name.fl_str_mv Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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