Jacobs Journal of Emergency Medicine

The Effect of Heparin Administration on In-Hospital Mortality in Patients with Aortic Dissection

*Alfred Tager
Department Of Emergency Medicine, Charleston Area Medical Center Health Education And Research Institute, United States

*Corresponding Author:
Alfred Tager
Department Of Emergency Medicine, Charleston Area Medical Center Health Education And Research Institute, United States
Email:Alfred.tager@camc.org

Published on: 2019-10-03

Abstract

Objectives: Aortic Dissection (AD) and Acute Coronary Syndrome (ACS) have overlapping symptomatology that make differentiating them difficult. This sometimes results in patients with AD inadvertently receiving anticoagulation. The aim of this study was to determine if the administration of heparin to patients with AD increased in-hospital mortality.
Methods: A retrospective chart review of patients with AD admitted to a large academic hospital between 2010 and 2015 was performed. Patients with the diagnosis of type A AD or type B AD who were greater than or equal to 18 you were included. Exclusion criteria consisted of trauma, thrombolytic administration, and history of anticoagulant use. The in-hospital mortality of patients who received anticoagulation was compared to those who did not.
Results: A total of 131 patients were eligible for the study. 36 (27%) of the 131 patients received heparin; other comorbidities including Hypertension, Diabetes, and Hyperlipidemia were also studied. In-hospital mortality was found to be 9 times higher in patients with type A AD who received heparin compared to the non-heparin group. Patients with a diagnosis of type B AD who received heparin had a negative statistically non-significant correlation with mortality.
Conclusion: Patients with type A AD who receive heparin are 9 times more likely to have in-hospital mortality than those who did not. This study advises a cautious utilization of anticoagulants in acute, undifferentiated chest pain in the emergency department. Such a finding is of great significance to our fellow emergency medicine physicians considering the similar manifestations of AD and ACS. Although, patients with type B AD who receive heparin showed lower in-hospital mortality compared with those who didn’t received Heparin, our data was not powerful enough to show a statistically significant outcome.

Keywords

Heparin; Aortic Dissection; Acute Aortic Syndrome; Anticoagulation; Acute Coronary Syndrome

Introduction

Aortic Dissection (AD) is a potentially fatal aortic pathology classified according to the Stanford system into type A AD that involves the ascending aorta and possibly the descending aorta, and type B AD which only involves the descending aorta [1]. Type A AD are typically managed surgically, the mortality rate for type A AD managed surgically is around 22%, whereas in those managed medically, the mortality rate is 57%. Type B AD is typically managed medically, but in the last two decades, endovascular intervention has become an increasingly popular option [2]. Patients with type B AD who are managed medically have a mortality rate approaching 10%, whereas that undergoing endovascular repair is approximately 10.6%.