PMID- 38223849
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240116
IS  - 2666-688X (Electronic)
IS  - 2666-688X (Linking)
VI  - 61
DP  - 2024
TI  - The Impact of Intra-Operative Heparin on Thromboembolism and Death in a Matched 
      Cohort of Patients with a Ruptured Abdominal Aortic Aneurysm.
PG  - 20-26
LID - 10.1016/j.ejvsvf.2023.11.004 [doi]
AB  - OBJECTIVE: Portuguese nationwide estimates indicate that 20% of abdominal aortic 
      aneurysms (AAAs) are treated when ruptured. In these cases, intra-operative 
      unfractionated heparin (UFH) usage rates vary widely. Evidence on this topic is 
      scarce and focused on patients treated by open repair (OSR). The aim was to 
      determine the influence of UFH on peri-operative thromboembolic events (TEs) and 
      death in a cohort of ruptured AAA (rAAA). METHODS: Retrospective, single-centre, 
      comparative study. From 2011 to April 2023, all consecutive rAAAs (endovascular 
      repair [EVAR] and OSR) were considered. Primary outcomes were 30-day TE free 
      survival and TE rates. The secondary outcome was 30-day death. Safety endpoints 
      were procedural blood loss, blood product requirements, and secondary 
      interventions due to haemorrhage. Using propensity score matching (PSM) each UFH 
      patient was matched with one no UFH patient in a 1:1 ratio. RESULTS: The study 
      included 250 patients. After PSM, 190 patients were analysed (EVAR: 60.0% no-UFH 
      vs. 64.4% UFH). TE free survival estimates favoured the UFH group (67.3% vs. 
      47.2%, p = .009; UFH adjusted odds ratio [aOR] 2.01, 95% confidence interval [CI] 
      1.04-4.17). TEs were more frequent in the no UFH group (20.0% vs. 44.2% patients, 
      p < .001; UFH aOR 0.31, 95% CI 0.15-0.65 for any TE), driven by an increase in 
      bowel ischaemia (17.9% no UFH vs. 3.2% UFH, p = .001). Most events occurred in 
      the first 72 hours. EVAR was associated with reduced TE and improved TE free 
      survival (aOR 0.20, 95% CI 0.09-0.45 and aOR 5.54, 95% CI 2.34-13.08, 
      respectively). No significant differences in 30-day survival were noted (75% 
      no-UFH vs. 83% UFH, p = .26; aOR 1.08, 95% CI 0.48-2.43) nor in blood loss, 
      peri-operative red blood cell and fresh frozen plasma requirements, or secondary 
      interventions due to haemorrhage (p = .10; p = .11; p = .13 and p = .18 
      respectively). CONCLUSION: In this cohort, intra-operative UFH was safe and 
      associated with improved TE free survival, driven by a reduction in bowel 
      ischaemia. Conversely, mortality remained unaffected. Randomised controlled 
      trials are required to confirm these findings.
CI  - (c) 2023 The Author(s).
FAU - Ribeiro, Tiago F
AU  - Ribeiro TF
AD  - Hospital de Santa Marta, Centro Hospitalar Universitario de Lisboa Central, 
      Lisboa, Portugal.
FAU - Correia, Ricardo
AU  - Correia R
AD  - Hospital de Santa Marta, Centro Hospitalar Universitario de Lisboa Central, 
      Lisboa, Portugal.
FAU - Soares Ferreira, Rita
AU  - Soares Ferreira R
AD  - Hospital de Santa Marta, Centro Hospitalar Universitario de Lisboa Central, 
      Lisboa, Portugal.
AD  - NOVA Medical School|Faculdade de Ciencias Medicas, NMS|FCM, Universidade NOVA de 
      Lisboa, Lisbon, Portugal.
FAU - Bastos Goncalves, Frederico
AU  - Bastos Goncalves F
AD  - Hospital de Santa Marta, Centro Hospitalar Universitario de Lisboa Central, 
      Lisboa, Portugal.
AD  - NOVA Medical School|Faculdade de Ciencias Medicas, NMS|FCM, Universidade NOVA de 
      Lisboa, Lisbon, Portugal.
AD  - Hospital CUF Tejo, Lisbon, Portugal.
FAU - Amaral, Carlos
AU  - Amaral C
AD  - Hospital de Santa Marta, Centro Hospitalar Universitario de Lisboa Central, 
      Lisboa, Portugal.
FAU - Ferreira, Maria Emilia
AU  - Ferreira ME
AD  - Hospital de Santa Marta, Centro Hospitalar Universitario de Lisboa Central, 
      Lisboa, Portugal.
LA  - eng
PT  - Journal Article
DEP - 20231124
PL  - England
TA  - EJVES Vasc Forum
JT  - EJVES vascular forum
JID - 101766732
PMC - PMC10784139
OTO - NOTNLM
OT  - Abdominal aortic aneurysm
OT  - Event free survival
OT  - Ruptured aortic aneurysms
OT  - Thromboembolism
OT  - Unfractionated heparin
COIS- Frederico Bastos Goncalves has received speaker and proctoring fees from W.L. 
      Gore, Medtronic, and Cook Medical.
EDAT- 2024/01/15 06:42
MHDA- 2024/01/15 06:43
PMCR- 2023/11/24
CRDT- 2024/01/15 04:55
PHST- 2023/07/17 00:00 [received]
PHST- 2023/10/17 00:00 [revised]
PHST- 2023/11/19 00:00 [accepted]
PHST- 2024/01/15 06:43 [medline]
PHST- 2024/01/15 06:42 [pubmed]
PHST- 2024/01/15 04:55 [entrez]
PHST- 2023/11/24 00:00 [pmc-release]
AID - S2666-688X(23)00091-6 [pii]
AID - 10.1016/j.ejvsvf.2023.11.004 [doi]
PST - epublish
SO  - EJVES Vasc Forum. 2023 Nov 24;61:20-26. doi: 10.1016/j.ejvsvf.2023.11.004. 
      eCollection 2024.