Blood groups and acute aortic dissection type III

Non-O blood group is associated with lower risk of in-hospital mortality in non-surgically managed patients with type A aortic dissection

BACKGROUND

The association between different ABO blood groups and mortality of aortic dissection (AD) remains controversial. This study aimed to examine whether different ABO blood groups affect the prognosis of AD.

METHODS

Demographic and clinical data were collected from 877 patients diagnosed with AD from 2015 to 2019 in the First Affiliated Hospital of Shantou University Medical College. The association between in-hospital mortality of AD patients and ABO blood group was analyzed using Cox proportional hazards regression models.

RESULTS

This retrograde cohort study demonstrated that for 877 patients, male gender, non-O blood group, Stanford type B AD (TBAD), higher presenting systolic and diastolic blood pressure, and being a recipient of aortic arch replacement surgery (surgery) or endovascular stent-graft implantation (stent-graft) were associated with decreased in-hospital mortality of AD. In Cox proportional hazards models, non-O blood group was associated with lower risk of early mortality regardless of adjustment (HR = 0.668, 95% confidence interval [CI] 0.473-0.944 before adjustment, HR = 0.662, 95% CI 0.468-0.935 after adjustment for age and sex, and HR = 0.641, 95% CI 0.453-0.906 after adjustment for AD types, SBP and surgery). Further analyses revealed that for patients diagnosed with type A AD (TAAD), non-O blood group renders a significant 34.3% decrease in the risk of in-hospital mortality compared with blood group O. Specifically, this difference in mortality risk was found among TAAD patients who did not undergo surgery (HR = 0.579, 95% CI 0.377-0.889), rather than those who did. There was no significant difference in early mortality for patients with TBAD, whether or not stent-grafts were implanted.

CONCLUSIONS

Non-O blood type decreases the risk of in-hospital mortality, especially for TAAD, in AD patients without surgical intervention. More attention must be paid to blood type O TAAD patients without surgical interventions, and early surgical intervention may be an effective means to decrease in-hospital mortality of TAAD.

ABO blood group and the risk of aortic disease: a nationwide cohort study

OBJECTIVES

To analyse the association between ABO blood group and aortic disease using data on blood donors and transfused patients from Sweden.

DESIGN

This was a retrospective study using data from the Swedish portion of the Scandinavian Donations and Transfusions Database. The association between ABO blood group and aortic disease was analysed using log-linear Poisson regression models and presented as incidence rate ratios (IRRs).

SETTING

Swedish population-based study.

PARTICIPANTS

The study cohort consisted of 1 164 561 Swedish blood donors and 961 637 transfused patients with a combined follow-up time of 29 390 649 person-years.

PRIMARY AND SECONDARY OUTCOME MEASURES

IRRs of aortic events (ie, aortic aneurysms and/or aortic dissections) in relation to patient blood group.

RESULTS

A total of 20 684 aortic events occurred during the study period. Non-O donors and patients had similar incidence of aortic events when compared with blood group O donors and patients with an IRR of 0.98 (95% CI, 0.93-1.04) and 1.00 (95% CI, 0.97-1.03), respectively. There were no differences between non-O and blood group O individuals when aortic dissections and aortic aneurysms were analysed separately. Blood group B conferred a lower risk of aortic aneurysms in the patient cohort when compared with blood group O (IRR, 0.90; 95% CI, 0.85-0.96).

CONCLUSIONS

In the present study, there were no statistically significant associations between ABO blood group and the risk of aortic disease. A possible protective effect of blood group B was observed in the patient cohort but this finding requires further investigation.

Effect of tranexamic acid on symptomatic venous thromboembolism in patients undergoing primary total knee arthroplasty

INTRODUCTION

This study aimed to investigate the effect of tranexamic acid (TXA) with sequential routine anticoagulation on postoperative symptomatic venous thromboembolism (VTE) in patients undergoing primary total knee arthroplasty (TKA).

MATERIAL AND METHODS

This was a prospective study with randomized trials. From January 2013 to May 2015, 1880 patients undergoing primary TKA were enrolled in this study. Seven hundred and twenty patients who received TXA injection were included in the TXA group while 1160 patients who received placebo injection were included in the control group. Patients in the TXA group were treated with intravenous TXA or topical intravenous TXA, and all received sequential routine anticoagulation 12 h after the operation. We extracted data of patients' sex, age, primary diagnoses, and comorbidities that could potentially affect the prevalence rate of VTE. To discuss the risk factors of symbolic VTE, comparisons were made within the TXA group between patients with symbolic VTE and non-symbolic VTE. Logistic regression analysis was performed to analyze the concurrent effects of various factors on the prevalence rate of postoperative VTE.

RESULTS

Thigh perimeter was not closely associated with TXA injection. Within the TXA group, 24 (3.3%) patients had perioperative symptomatic VTE, 16 (2.2%) deep vein thrombosis (DVT) and 8 (1.1%) pulmonary embolism. High body mass index (BMI), low fibrinogen (Fbg) and simultaneous bilateral TKA were significant risk factors in both univariate analysis and multivariate analysis.

CONCLUSIONS

Increased BMI, low Fbg, and simultaneous bilateral TKA could act as risk factors for postoperative symptomatic VTE treated with TXA.