The Use of Heparin during Open Repair of Ruptured Abdominal Aortic Aneurysm is Safe and Reduces Mortality

Abstract

Introduction: The use of systemic heparin during open repair of ruptured abdominal aortic aneurysms (rAAA) remains contentious with no clear guidelines. The purpose of this study is to investigate the effects of intraoperative heparin on perioperative outcomes after open rAAA repair. Methods: The Vascular Quality Initiative (VQI) database was queried for all patients that received open repair for rAAAs from 2011 to 2021. Perioperative outcomes included mortality, myocardial infarction, permanent dialysis, lower extremity ischemia, bowel ischemia, stroke and return to OR for any reason or for bleeding. Results: A total of 2,209 patients underwent open rAAA repair, of which, 80.7% received intraoperative heparin. Patients in the non-heparin group had significantly larger aneurysms (P = 0.044) and were more likely to be hemodynamically unstable with lower minimum systolic blood pressure and higher rates of cardiac arrest (P < 0.001). In contrast, the symptoms-to-intervention time was significantly longer in the heparin group (P = 0.002). On univariable analysis, patients in the heparin group exhibited significantly lower rates of perioperative mortality (30.4%vs59.9%, P < 0.001) and return to OR for bleeding (7.3%vs11.4%, P = 0.007). After adjustment, the use of heparin was associated with a 52% decrease in the risk of death (aOR,0.48;95% CI,0.36-0.66;P <0.001) and a 34% decrease in the risk of reexploration for bleeding (aOR,0.66;95% CI,0.46-0.94;P = 0.021). Conclusion: The use of heparin during open repair of rAAA in a real-world setting was associated with a significant decrease in the risk of death without increasing the risk of bleeding and postoperative complication. These findings suggest that the use of heparin is safe in open rAAAs.