Additional file 1 of Does preoperative antiplatelet therapy worsen outcomes in acute type A aortic dissection surgery? A meta-analytic review

Supplementary Material 1. Supplementary Figure 1a to 4b: Forest plots for all the outcomes assessed in the total cohort. Figure 1a Mortality: There was no significant difference in 30-day mortality between APT and No APT groups [OR 1.3; 95% CI 0.7 to 2.7; p = 0.38; I² = 64%]. Figure 1b Reoperation for bleeding: The rate of reoperation for bleeding was comparable between the APT and No APT [OR 1.0; 95% CI 0.4 to 2.5; p = 0.98; I² = 61%]. Figure 1c Transfused Plasma: APT did not result in a significant increase in plasma transfusion compared to No APT [MD 117.9 mL; 95% CI -266.3 to 502.1; p = 0.40; I² = 0%]. Figure 1d Postoperative Bleeding (within 12 hours): Postoperative bleeding within 12 hours was comparable between the APT and No APT cohorts [MD 75.6 mL; 95% CI -80.9 to 232.1; p = 0.17; I² = 0%]. Figure 2a Operation time: There was no significant difference in operation time between APT and No APT groups [MD: 19.2 minutes; 95% CI -22.9 to 61.3; p = 0.24; I² = 50%]. Figure 2b CPB time: Cardiopulmonary bypass time was similar between APT and No APT groups, with no statistically significant difference [MD 4.4 minutes; 95% CI -6.1 to 14.9; p = 0.27; I² = 0%]. Figure 2c ACC time: No significant difference was observed in ACC time between APT and No APT group [MD -0.6 minutes; 95% CI -5.5 to 4.4; p = 0.67; I² = 0%]. Figure 2d CA time: The mean difference in circulatory arrest time between APT and No APT groups was not statistically significant [MD 0.5 minutes; 95% CI -3.1 to 4.1; p = 0.69; I² = 11%]. Figure 3a ICU Length of Stay: ICU length of stay was comparable between APT and No APT groups [MD -0.6 days; 95% CI -2.0 to 0.8; p = 0.26; I² = 53%]. Figure 3b Myocardial Infarction: The incidence of MI did not differ significantly between APT and No APT [OR 1.4; 95% CI 0.5 to 4.0; p = 0.29; I² = 0%]. Figure 3c Stroke: Postoperative stroke rates were similar between the two groups [OR 0.9; 95% CI 0.6 to 1.3; p = 0.55; I² = 0%]. Figure 3d Acute Kidney Injury: The incidence of postoperative AKI was comparable between groups [OR 0.8; 95% CI 0.2 to 3.1; p = 0.50; I² = 66%]. Figure 3e Cardiac Tamponade: The rates of cardiac tamponade showed no statistically significant difference between APT and No APT [OR 1.2; 95% CI 0.8 to 1.7; p = 0.45; I² = 47%]. Figure 4a to 4f: Forest plots illustrating the primary outcomes in the subgroup analysis comparing propensity-matched APT and No APT patients. Figure 4a Mortality: There was no significant difference in 30-day mortality between APT and No APT groups [OR 1.2; 95% CI 0.4 to 3.2; p = 0.65; I² = 52%]. Figure 4b Reoperation for Bleeding: Reoperation for bleeding was comparable between APT and No APT groups, with no statistically significant difference [OR 0.9; 95% CI 0.3 to 2.6; p = 0.63; I² = 35%]. Figure 4c Red Blood Cells Transfused: The number of RBC units transfused was comparable between APT and No APT groups, with no statistically significant difference [MD 2.1 units; 95% CI -0.5 to 4.7; p = 0.11; I² = 82%]. Figure 4d Platelets Transfused: APT did not significantly impact platelet transfusion requirements compared to No APT [MD 2.1 units; 95% CI -0.5 to 4.7; p = 0.11; I² = 82%]. Figure 4e Transfused Plasma: The need for plasma transfusion was similar in both APT and No APT groups. [MD 162.6 mL; 95% CI -1,103.1 to 1,428.3; p = 0.35; I² = 12%]. Supplementary Figure 4f Use of rFVIIa: rFVIIa requirements were significantly higher in the APT group compared to the No APT group [OR 1.8; 95% CI 1.2 to 2.9; p = 0.008; I² = 0%]. Figure 5a to 5e: Forest plots illustrating the primary outcomes in the subgroup analysis comparing DAPT-only and No APT patients. Figure 5a Mortality: There was no statistically difference in mortality rates between DAPT and No APT groups. [OR 1.0; 95% CI 0.6 to 1.6; p = 0.95; I² = 0%]. Figure 5b Reoperation for Bleeding: Reoperation for bleeding was comparable between the DAPT and No APT groups [OR 1.0; 95% CI 0.1 to 10.1; p = 0.98; I² = 0%]. Figure 5c Red Blood Cells Transfused: DAPT was associated with significantly higher RBC transfusion requirements compared to No APT [MD 1.8 units; 95% CI 0.5 to 3.2; p = 0.009; I² = 0%]. Figure 5d Platelets Transfused: Platelet transfusion requirements were comparable between DAPT and No APT groups [MD 1.1 units; 95% CI -13.7 to 16.0; p = 0.51; I² = 96%]. Figure 5e Use of rFVIIa: No significant difference in fFVIIa requirements was observed between DAPT and No APT groups [OR 2.0; 95% CI 1.2 to 3.3; p = 0.01; I² = 0%]