Coagulopathy Management of an Acute Type A Aortic Dissection in a Patient Taking Apixaban

This paper reports the successful management of a patient with acute type A Penn B thoracic aortic dissection who was on apixaban therapy for atrial fibrillation. Emergency surgery was performed due to the patient's clinical deterioration, with innominate artery compromise and severe aortic valve regurgitation. The anesthesia team used point-of-care rotational thromboelastometry-guided coagulation replacement therapy consisting of prothrombin concentrate, fibrinogen, and platelets. The surgical team used a complementary approach with topical hemostatic agents and a pericardial patch. No additional blood products were required. The patient recovered fully and was discharged home.