Efficiency of hemostatic agents and postoperative complications in emergency surgical repair of an aortic dissection

Written by Katona Hajna, Kovács Judit

Despite modern surgical techniques, massive postoperative hemorrhage is frequent after surgical repair of an aortic dissection. The cause of coagulation disorders are the activation of coagulation cascade by the exposure of blood to the artificial surface of the extracorporeal circuit and the consumption coagulopathy associated with aortic dissection. In order to correct bleeding disorders clotting factors, anti-fibrinolytics (tranexamic acid) and platelet concentrates can be administered. This paper aims to present the effectiveness of procoagulant therapy and the postoperative complications in a 55 years old patient with aortic dissection. Emergency Bentall procedure was performed (composite graft replacement of the aortic valve and ascending aorta). Results. Because of postoperative bleeding, the patient received large amounts of blood and blood products, antifibrinolytic agent (tranexamic acid), recombinant factor VII (Novoseven) and prothrombin concentrate (pronativ). Complications that have developed postoperatively (neurological dysfunction and heart failure, renal failure, liver failure) were corrected in 14 days at intensive care unit. Conclusions. Following emergency reconstructive surgery of the ascending aorta, anatomic alterations can be restored, but due to coagulation disorders the patient’s life may be put in danger. In case of severe intra- and postoperative bleeding, procoagulant agents produce a rapid and effective hemostasis, but may increase the incidence of multiple organ dysfunctions. Treatment with hemostatic agents is efficient, but we must always have in mind the complications caused by them.


Keywords: coagulation disorders, multiple organ dysfunction, recombinant activated factor VII., prothrombin complex concentrate

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