From the Research
Aspirin should be withheld in the setting of an aortic dissection, as antiplatelet agents can potentially worsen bleeding complications and interfere with surgical management if needed. The primary goals in managing aortic dissection are controlling blood pressure, reducing the force of cardiac contractions (dP/dt), and maintaining hemodynamic stability. Instead of aspirin, patients typically receive medications like intravenous beta-blockers (such as esmolol, metoprolol, or labetalol) to reduce heart rate and blood pressure, sometimes followed by vasodilators like nicardipine or nitroprusside if blood pressure remains elevated after adequate heart rate control. These interventions aim to reduce shear stress on the aortic wall, prevent extension of the dissection, and reduce the risk of aortic rupture.
Some studies suggest that long-term oral low-dose aspirin may be safe for patients with both type B aortic dissection and coronary heart disease who underwent endovascular aortic repair 1. However, the most recent and highest quality study found that neither antiplatelet therapy nor anticoagulants were associated with long-term survival in patients with aortic dissection 2.
Key considerations in managing aortic dissection include:
- Controlling blood pressure and reducing cardiac contractility
- Maintaining hemodynamic stability
- Avoiding antiplatelet agents like aspirin
- Using beta-blockers and vasodilators as needed
- Considering surgical intervention if necessary
It is essential to prioritize the patient's safety and avoid any potential harm that aspirin may cause in the setting of an aortic dissection. If a patient with aortic dissection is already taking aspirin for another indication, it should be temporarily discontinued until the acute management phase is complete and surgical intervention, if required, has been performed. The use of oral beta-blockers has been associated with significant protection against in-hospital mortality and stroke following repair of type B aortic dissection 3.