Results:
ROTEM (INTEM, EXTEM, HEPTEM and FIBTEM) was tested at 6 points in time
before, during and after surgery for ATAAD or elective aortic surgery.
The ATAAD group had an activated coagulation coming into the surgical
theatre. The two groups showed activation of both major coagulation
pathways during surgery, but the ATAAD group consistently had larger
deficiencies. Reversal of the coagulopathy was successful, although none
of the groups reached elective baseline until postoperative day 1. ROTEM
did not detect low levels of clotting factors at heparin reversal nor
low levels of platelets.
Conclusions: This study
demonstrated that ATAAD is associated with a coagulopathic state.
Surgery causes additional damage to the hemostatic system in ATAAD
patients as well as in patients undergoing elective surgery of the
ascending aorta or the aortic root. ROTEM does not adequately catch the
full coagulopathy in ATAAD. A transfusion protocol in ATAAD should be
specifically created to target this complex coagulopathic state and
ROTEM does not negate the need for routine laboratory tests.
KEY WORDS: Aorta, Aneurysm, Dissection, Bleeding, Rotational
thromboelastometry, ROTEM