Predictive value of preoperative platelet count and D-dimer levels for spinal cord injury following acute type a aortic dissection

Journal of Cardiothoracic Surgery, 2024 · DOI: https://doi.org/10.1186/s13019-024-02597-y · Published: March 5, 2024

Spinal Cord Injury Cardiovascular Science Surgery

Simple Explanation

This study aims to identify the risk factors contributing to spinal cord injury (SCI) following a type A acute aortic dissection (TA-AAD). This retrospective study was conducted at a single center and involved 481 patients who received frozen elephant trunk stent implantation for TA-AAD. The findings indicate that preoperative platelet count and D-dimer levels are independent risk factors for postoperative SCI in patients with TA-AAD.

Study Duration

September 2016 to April 2020

Participants

481 patients who received frozen elephant trunk stent implantation for TA-AAD

Evidence Level

Retrospective study

Key Findings

1
Preoperative platelet count (odds ratio [OR] = 0.774) and D-dimer levels (OR = 2.247) could serve as independent predictors for postoperative SCI in patients with TA-AAD.
2
SCI was classified according to the criteria established by the American Spinal Injury Association (ASIA; https://asia-spinalinjury.org/) into five grades.
3
The analysis identified preoperative platelet count (odds ratio [OR] = 0.774, 95% confidence interval [CI] 0.416–0.895, P = 0.007) and D-dimer levels (OR = 2.247, 95% CI 1.756–4.226, P = 0.016) as independent risk factors for SCI after TA- AAD.

Research Summary

This study aims to identify the risk factors contributing to spinal cord injury (SCI) following a type A acute aortic dissection (TA-AAD). The resulting data of the multivariate logistic regression analysis demonstrated that preoperative platelet count (odds ratio [OR] = 0.774) and D-dimer levels (OR = 2.247) could serve as independent predictors for postoperative SCI in patients with TA-AAD. The findings indicate that preoperative platelet count and D-dimer levels are independent risk factors for postoperative SCI in patients with TA-AAD.

Practical Implications

Risk Stratification

Preoperative platelet count and D-dimer levels can be used to identify patients at high risk for postoperative SCI after TA-AAD.

Preventive Measures

Proactive management strategies and preventive measures are recommended for patients with reduced preoperative platelet count and elevated D-dimer levels to mitigate the risk of postoperative SCI.

Anticoagulation Therapy

Postoperative heparin anticoagulation may be considered to slow the progression of thrombosis in the false lumen and promote the establishment of collateral spinal cord circulation in high-risk patients.

Study Limitations

1
Data were retrieved from a single medical center with a relatively small size for this retrospective study, which may have introduced selection bias.
2
This study did not consider factors such as the individual experience of surgeons and variations in treatment philosophies of different medical institutions, which might have influenced the results.
3
Further prospective studies are still needed to substantiate these results.

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