From the Research
For patients with aortic dissection and myocardial infarction (MI), the recommended PTT (partial thromboplastin time) goal is typically 60-80 seconds, which corresponds to 1.5-2 times the normal control value, as supported by the most recent and highest quality study available 1. This approach is crucial in balancing the need to prevent thrombus formation in the setting of MI while minimizing the risk of bleeding complications that could be catastrophic in aortic dissection. Key considerations in managing these patients include:
- Achieving the target PTT range using intravenous unfractionated heparin, with an initial bolus and continuous infusion adjusted according to a standardized nomogram.
- Maintaining strict blood pressure control simultaneously, with a systolic target of 100-120 mmHg, using beta-blockers as first-line agents.
- Considering the specific type of dissection (Stanford A vs B) and the patient's bleeding risk factors when modifying the anticoagulation approach.
- Being aware of the high risk of in-hospital mortality and the importance of early reperfusion strategies, such as percutaneous coronary intervention (PCI) as a bridge to surgical repair, as highlighted in recent studies 1, 2. The management of patients with aortic dissection and MI requires careful consideration of these factors to optimize outcomes and minimize morbidity and mortality.