Characteristics and Treatment Outcomes of Acute Type A Aortic Dissection With Elevated D-Dimer Concentration

Background-Clinical characteristics and treatment outcomes of acute type A aortic dissection with D-dimer elevation have not been clarified. Methods and Results-D-dimer was measured preoperatively within 24 hours of symptom onset in 262 patients with acute type A aortic dissection. The median (and interquartile range) admission D-dimer concentration in our total patient group was 26.7 (8.3-85.9) mu g/mL. Median (interquartile range) D-dimer concentrations were 5.0 (2.6-18.0) mu g/mL for complete false lumen thrombosis (n=33), 60.9 (19.4-160.4) mu g/mL for partial thrombosis (n=81), 26.5 (10.0-70.6) mu g/mL for a patent false lumen (n=131), and 8.7 (3.2-26.9) mu g/mL for ulcerlike projection (n=17) (P<0.01). With a D-dimer concentration of <= 8.3 mu g/mL representing the lower quartile, we then investigated predictors of a low D-dimer level. Multivariate analysis showed dissection limited to the ascending aorta (P<0.01; odds ratio, 9.81) or descending aorta (P<0.01; odds ratio, 7.68), a completely thrombosed false lumen (P<0.01; odds ratio, 4.02), and absence of brain ischemia (P=0.013; odds ratio, 4.74) to be predictors of the lower D-dimer concentration. Compared with patients with a low D-dimer concentration (<= 8.3 mu g/mL, n=66), patients with a D-dimer concentration > 8.3 mu g/mL (n=196) had a reduced preoperative platelet count and increased operation time and transfusion volume. In-hospital mortality was elevated in this group (1.5% versus 11.2%; P=0.031), although 7-year survival did not differ for hospital survivors (lower versus higher, 93.1% versus 79.1%; P=0.21). Conclusions-D-dimer concentrations are strongly influenced by the extent of dissection and false lumen status. Operative risks are increased in patients with a relatively high D-dimer concentration.