The effect of postoperative anticoagulation on acute aortic dissection: a systematic review and meta-analysis
Background and aimThe evolution of the false lumen after the repair of acute aortic dissection has been linked to numerous adverse clinical outcomes, including increased late mortality and a higher risk of reoperation. Despite the widespread use of chronic anticoagulation in patients who have underg...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-05-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1173945/full |
| _version_ | 1797830068264763392 |
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| author | Xiangfeng Gong Qianlei Lang Chaoyi Qin Chaoyi Qin Wei Meng Wei Meng Zhenghua Xiao Zhenghua Xiao |
| author_facet | Xiangfeng Gong Qianlei Lang Chaoyi Qin Chaoyi Qin Wei Meng Wei Meng Zhenghua Xiao Zhenghua Xiao |
| author_sort | Xiangfeng Gong |
| collection | DOAJ |
| description | Background and aimThe evolution of the false lumen after the repair of acute aortic dissection has been linked to numerous adverse clinical outcomes, including increased late mortality and a higher risk of reoperation. Despite the widespread use of chronic anticoagulation in patients who have undergone repair for acute aortic dissection, the effects of this therapy on false lumen evolution and its subsequent consequences are yet to be fully understood. This meta-analysis aimed to investigate the impact of postoperative anticoagulation on patients with acute aortic dissection.MethodsIn PubMed, Cochrane Libraries, Embase, and Web of Science, we performed a systematic review of nonrandomized studies, comparing outcomes with postoperative anticoagulation vs. non-anticoagulation on aortic dissection. We investigated the status of false lumen (FL), aorta-related death, aortic reintervention, and perioperative stroke in aortic dissection patients with anticoagulation and non-anticoagulation.ResultsAfter screening 527 articles, seven non-randomized studies were selected, including a total of 2,122 patients with aortic dissection. Out of these patients, 496 received postoperative anticoagulation while 1,626 served as controls. Meta-analyses of 7 studies revealed significantly higher FL patency in Stanford type A aortic dissection (TAAD) postoperative anticoagulation with an OR of 1.82 (95% CI: 1.22 to 2.71; Z = 2.95; I²=0%; P = 0.93). Moreover, there was no statistically significant difference between the two groups in aorta-related death, aortic reintervention, and perioperative stroke with an OR of 1.31 (95% CI: 0.56 to 3.04; Z = 0.62; I² = 0%; P = 0.40), 0.98 (95% CI: 0.66 to 1.47; Z = 0.09; I² = 23%; P = 0.26), 1.73 (95% CI: 0.48 to 6.31; Z = 0.83; I² = 8%; P = 0.35), respectively.ConclusionsPostoperative anticoagulation was associated with higher FL patency in Stanford type A aortic dissection patients. However, there was no significant difference between the anticoagulation and non-anticoagulation groups in terms of aorta-related death, aortic reintervention, and perioperative stroke. |
| first_indexed | 2024-04-09T13:30:13Z |
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| id | doaj.art-f4dd9ca148b743f491876c389e3c059e |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-09T13:30:13Z |
| publishDate | 2023-05-01 |
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| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-f4dd9ca148b743f491876c389e3c059e2023-05-10T05:03:44ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2023-05-011010.3389/fcvm.2023.11739451173945The effect of postoperative anticoagulation on acute aortic dissection: a systematic review and meta-analysisXiangfeng Gong0Qianlei Lang1Chaoyi Qin2Chaoyi Qin3Wei Meng4Wei Meng5Zhenghua Xiao6Zhenghua Xiao7Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, ChinaDepartment of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, ChinaDepartment of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, ChinaCardiovascular Surgery Research Laboratory, West China Hospital, Sichuan University, Chengdu, ChinaDepartment of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, ChinaCardiovascular Surgery Research Laboratory, West China Hospital, Sichuan University, Chengdu, ChinaDepartment of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, ChinaCardiovascular Surgery Research Laboratory, West China Hospital, Sichuan University, Chengdu, ChinaBackground and aimThe evolution of the false lumen after the repair of acute aortic dissection has been linked to numerous adverse clinical outcomes, including increased late mortality and a higher risk of reoperation. Despite the widespread use of chronic anticoagulation in patients who have undergone repair for acute aortic dissection, the effects of this therapy on false lumen evolution and its subsequent consequences are yet to be fully understood. This meta-analysis aimed to investigate the impact of postoperative anticoagulation on patients with acute aortic dissection.MethodsIn PubMed, Cochrane Libraries, Embase, and Web of Science, we performed a systematic review of nonrandomized studies, comparing outcomes with postoperative anticoagulation vs. non-anticoagulation on aortic dissection. We investigated the status of false lumen (FL), aorta-related death, aortic reintervention, and perioperative stroke in aortic dissection patients with anticoagulation and non-anticoagulation.ResultsAfter screening 527 articles, seven non-randomized studies were selected, including a total of 2,122 patients with aortic dissection. Out of these patients, 496 received postoperative anticoagulation while 1,626 served as controls. Meta-analyses of 7 studies revealed significantly higher FL patency in Stanford type A aortic dissection (TAAD) postoperative anticoagulation with an OR of 1.82 (95% CI: 1.22 to 2.71; Z = 2.95; I²=0%; P = 0.93). Moreover, there was no statistically significant difference between the two groups in aorta-related death, aortic reintervention, and perioperative stroke with an OR of 1.31 (95% CI: 0.56 to 3.04; Z = 0.62; I² = 0%; P = 0.40), 0.98 (95% CI: 0.66 to 1.47; Z = 0.09; I² = 23%; P = 0.26), 1.73 (95% CI: 0.48 to 6.31; Z = 0.83; I² = 8%; P = 0.35), respectively.ConclusionsPostoperative anticoagulation was associated with higher FL patency in Stanford type A aortic dissection patients. However, there was no significant difference between the anticoagulation and non-anticoagulation groups in terms of aorta-related death, aortic reintervention, and perioperative stroke.https://www.frontiersin.org/articles/10.3389/fcvm.2023.1173945/fullacute aortic dissectionpostoperative anticoagulationfalse lumenaorta-related deathmeta-analysis. |
| spellingShingle | Xiangfeng Gong Qianlei Lang Chaoyi Qin Chaoyi Qin Wei Meng Wei Meng Zhenghua Xiao Zhenghua Xiao The effect of postoperative anticoagulation on acute aortic dissection: a systematic review and meta-analysis Frontiers in Cardiovascular Medicine acute aortic dissection postoperative anticoagulation false lumen aorta-related death meta-analysis. |
| title | The effect of postoperative anticoagulation on acute aortic dissection: a systematic review and meta-analysis |
| title_full | The effect of postoperative anticoagulation on acute aortic dissection: a systematic review and meta-analysis |
| title_fullStr | The effect of postoperative anticoagulation on acute aortic dissection: a systematic review and meta-analysis |
| title_full_unstemmed | The effect of postoperative anticoagulation on acute aortic dissection: a systematic review and meta-analysis |
| title_short | The effect of postoperative anticoagulation on acute aortic dissection: a systematic review and meta-analysis |
| title_sort | effect of postoperative anticoagulation on acute aortic dissection a systematic review and meta analysis |
| topic | acute aortic dissection postoperative anticoagulation false lumen aorta-related death meta-analysis. |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1173945/full |
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