PREOPERATIVE COAGULOPATHY IN RUPTURED ABDOMINAL AORTIC-ANEURYSM PREDICTS POOR OUTCOME

In a prospective study of 50 consecutive patients undergoing operation for ruptured abdominal aortic aneurysm, a coagulation screen was perf ormed on admission to hospital. Twenty patients with either a platelet count < 100 x 10(9)/l or a prothrombin time > 1.5 times the control v alue had a mortality rate of 65 per cent (95 per cent confidence inter val 45-85 per cent); a further 23 patients with normal screen results had a mortality rate of 9 per cent (95 per cent confidence interval 0- 20 per cent) (P < 0.001). Seven patients, of whom three died, did not have an admission coagulation screen performed. Patient age in the stu dy group did not have independent statistical predictive power. This s tudy indicates that coagulopathy at the time of admission predicts poo r outcome inpatients with ruptured aortic aneurysm. Current management strategies are inadequate for the treatment of these patients, who ca n be rapidly identified on admission by means of platelet and prothrom bin counts.