Preoperative clinical application of human fibrinogen in patients with acute Stanford type A aortic dissection: A single‐center retrospective study

To evaluate the perioperative clinical efficacy of preoperative human fibrinogen treatment in patients with acute Stanford type A aortic dissection (ATAAD).


| INTRODUCTION
Aortic dissection (AD) is a life-threatening condition, and acute Stanford type A aortic dissection (ATAAD) carries the highest mortality among all AD types. Studies have shown that mortality from AD is highest in the first 48 h after the onset of symptoms, which can be more than 50%, and the highest mortality within 2 weeks can be more than 80%. [1][2][3] Therefore, the primary management of ATAAD is emergency surgery, which is the only effective treatment. 4,5 Despite the continual improvement in surgical techniques, the rates of surgical complications, morbidity, and mortality remain high. 6,7 Bleeding is one of the most common complications after ATAAD.
Bleeding complications with ATAAD have not been adequately evaluated yet. [8][9][10][11] Previous studies have shown that ATAAD can cause coagulation disorders. 12,13 Several studies have shown that patients with ATAAD have significant coagulation/fibrinolysis abnormalities before surgery. 14 Preoperatively, when the blood flows through the pseudolumen of nonendothelial tissue in patients with AD, it comes in contact with the damaged tissue, leading to turbulence. These factors can effectively activate the coagulation/ fibrinolytic system and platelets, resulting in the formation of thrombi and consumption of large amounts of clotting factors. Simultaneously, the inflammatory system is activated, and platelets are an important link to start the inflammatory response cascade. Many factors lead to the consumption of platelets in large quantities, thus reducing the number of platelets. Some researchers have shown that the degree of postoperative damage to coagulation factors and fibrinogen is greater than the degree of damage to platelet function. 15 Therefore, fibrinogen plays an important role in the occurrence and development of AD. Cardiopulmonary bypass (CPB) surgery further leads to dysfunction of the body's coagulation and fibrinolytic system, resulting in clotting-related complications. 16 This can lead to increased postoperative blood loss, increased perioperative blood product infusion, increased incidence of vital organ complications, and death. Therefore, in this study, patients with ATAAD who received fibrinogen as preoperative intravenous infusion were evaluated to explore the effect of fibrinogen on the prognosis of patients with intraoperative bleeding and postoperative bleeding-related complications, with the aim of providing a relevant theoretical basis for clinical treatment.

| Statistical analysis
Analyses were conducted using SPSS ® software (IBM ® Corporation).
Data are presented as mean ± standard deviation (SD), or median (25th, 75th quartiles). Fisher's exact test was applied for categoric variables, and the Mann-Whitney U test or Kruskal-Wallis test was applied for continuous variables. Univariate analysis and multivariate analyses were used to determine risk factors. Categorical data are given as the counts and percentage (n, %). A minimum p value of .05 was considered to be statistically significant.

| Results
There was no significant difference in the preoperative baseline data between the two groups (p > .05), and the data of the two groups were comparable. 3. The in-hospital mortality was similar in the two groups (2.9% vs. 9.3%, p = .122) ( Table 3).

| DISCUSSION
Acute aortic dissection (AAD) is a rare and life-threatening condition in which the blood flows from a tear in the intima of the aorta into the middle layer of the aorta. Untreated patients have a mortality rate of T A B L E 1 Preoperative data on the two patient groups that there is an activation of the coagulation system along with consumption coagulopathy. [21][22][23] Prolongation

| LIMITATIONS
This preliminary study has several limitations. One was the small sample that was retrospectively analyzed; however, it still has relevant statistical value. Based on the experience of the past 2 years and the results of this study, the author has designed a retrospective single-center controlled trial to determine whether preoperative use of fibrinogen in patients with ATAAD has clinical application value. All patients were administered the same dose, but there may be bias between different patients, as there is no standard LI ET AL.
| 3163 treatment regimen and individualized preoperative treatment was administered to different patients. We excluded patients with cardiac insufficiency, massive pericardial effusion, coronary atherosclerotic heart disease, cerebrovascular accident, and organ or limb malperfusion, which may have led to bias in the results. Therefore, further prospective randomized controlled studies are required.

| CONCLUSIONS
Preoperative use of human fibrinogen can reduce intraoperative blood loss and red blood cell transfusion requirement in patients undergoing surgery for ATAAD, in addition to shortening the operation time, reducing postoperative complications, and improving the early prognosis of patients, and being highly safe.

AUTHOR CONTRIBUTIONS
Liangwan Chen designed the study and submitted the manuscript.