Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Oct 4;62(5):ezac495.
doi: 10.1093/ejcts/ezac495.

ORal anticoagulation risks late aortic intervention in Conservatively managed type B Aortic dissection (ORCA study)

Katarzyna Jesse  1   2 , Lorenz Meuli  1 , Reinhard Kopp  1 , Benedikt Reutersberg  1 , Thomas Stadlbauer  1 , Alexander Zimmermann  1 , Philip Dueppers  1
Affiliations

ORal anticoagulation risks late aortic intervention in Conservatively managed type B Aortic dissection (ORCA study)

Katarzyna Jesse et al. Eur J Cardiothorac Surg. .

Abstract

Objectives: Single-center retrospective cohort study to evaluate the impact of oral anticoagulation (OAC) on long-term outcomes of conservatively managed acute type B aortic dissection.

Methods: Clinical and morphological data of eligible patients from a high-volume vascular centre from 1 January 2003 through 31 December 2020 were evaluated. Patients were excluded for: type A or non-A-non-B dissection, isolated abdominal dissection, intramural haematoma and connective tissue disease. The primary outcome was freedom from late aortic events (intervention, rupture and mortality). Secondary outcomes included spinal cord ischaemia, bleeding, reno-visceral artery occlusion, ilio-femoral intervention, dissection propagation, aortic growth, aortic remodelling, deterioration of false lumen thrombosis as well as 30-day and overall mortality. Time to event was analysed using multivariable Cox proportional hazard models with OAC as time-varying covariate and mortality as a competing risk. The impact of OAC was adjusted for potential confounding factors.

Results: A total of 69 patients [50 males, median age 65 (interquartile range: 58-72) years] were enrolled. The median follow-up was 49.3 (28-92) months. A total of 47 patients (68%) received OAC at any time throughout the follow-up for a median length of 26 (11-61) months. Late aortic events occurred in 28 patients (41%) including intervention (n = 27, 39%) and rupture (n = 1, 1%). OAC was associated with more late aortic events (hazard ratio 3.94, 95% confidence interval 1.06-14.6, P = 0.040). Secondary outcomes were not associated with OAC.

Conclusions: Our data suggest a relation of OAC therapy with an increased risk for late aortic interventions. Type B aortic dissection should not be the primary indication for OAC and patients with OAC for other indications require frequent follow-up imaging.

Keywords: Anticoagulant drugs; Anticoagulation; Antiplatelet therapy; Aortic dissection; Conservative management; Endovascular therapy.

PubMed Disclaimer

Comment in

  • ORCA can make a whale of a difference.
    Kreibich M, Berger T, Gottardi R. Kreibich M, et al. Eur J Cardiothorac Surg. 2022 Oct 4;62(5):ezac505. doi: 10.1093/ejcts/ezac505. Eur J Cardiothorac Surg. 2022. PMID: 36282528 No abstract available.

LinkOut - more resources