Preoperative APTT exceeding 34.5 s was independently associated with massive bleeding after type A aortic dissection repair and may, pending prospective validation, help identify patients who could potentially benefit from earlier hemostatic intervention.
Massive postoperative bleeding occurred in 18% of patients undergoing surgical repair for acute type A aortic dissection.
Patients with massive bleeding had significantly higher preoperative APTT compared to those without massive bleeding.
Preoperative creatinine levels were independently associated with massive postoperative bleeding.
Patients with massive bleeding had lower preoperative platelet counts than those without massive bleeding.
Longer cardiopulmonary bypass (CPB) time was an independent predictor of massive postoperative bleeding.
Hypertension was identified as an independent predictor of massive postoperative bleeding.
Patients with massive bleeding suffered more postoperative complications than those without massive bleeding.
Routine coagulation biomarkers PT (INR), fibrinogen, and D-dimer were not identified as independent predictors of massive bleeding in the multivariable model.
This research suggests that a common blood test called APTT (activated partial thromboplastin time), which measures how well blood clots, can help predict which patients undergoing emergency surgery for a dangerous condition called acute type A aortic dissection are at higher risk of severe bleeding afterward. In this study of 474 patients, about 18% experienced massive postoperative bleeding. Those who bled heavily tended to have higher APTT values and higher creatinine (a marker of kidney function) before surgery, as well as lower platelet counts. Patients with an APTT above 34.5 seconds were nearly three times more likely to experience massive bleeding compared to those with lower values. The study also found that longer time on the heart-lung bypass machine during surgery and having a history of high blood pressure (hypertension) were additional independent risk factors for massive postoperative bleeding. Notably, other commonly used clotting tests — such as PT (INR), fibrinogen, and D-dimer — were not identified as independent predictors of massive bleeding in this analysis, suggesting APTT may be especially informative among routine preoperative lab tests. This research suggests that measuring APTT before surgery could help surgeons and anesthesiologists identify patients who might benefit from earlier or more aggressive blood-clotting treatments to prevent life-threatening hemorrhage. However, the authors caution that these findings need to be confirmed in future prospective studies before being used to change clinical practice.
Norén E, Ede J, Larsson M, Nozohoor S, Sjögren J, Teurneau-Hermansson K. (2026). Preoperative levels of biomarkers of coagulation to predict massive bleeding after surgical repair for acute type A aortic dissection: a retrospective cohort study.. Journal of cardiothoracic surgery. https://doi.org/10.1186/s13019-026-04692-8