To the Editor.—
In the case report of aortic dissection occurring in a patient with chronic hemodialysis by Chiorazzi et al (228:1146, 1974), the purported relation of dissection to hemodialysis appears tenuous, since the onset occurred seven hours after the completion of hemodialysis. Any predisposition to dissecting aneurysm in patients with hemodialysis seems more likely to reflect the greater frequency of hypertension in such patients, known to be the most common predisposing factor in spontaneous dissecting aneurysm of the aorta.1Although the authors were inclined to regard anticoagulant (heparin) therapy as an augmenting factor in dissection, the onset (of dissection) at a time when the clotting profile was normal is against this hypothesis. We are not aware of published reports in which anticoagulant therapy is believed to have precipitated dissecting aneurysm. No single instance of aortic dissection has been recognized in the population of chronic anticoagulation clinics supervised by
Greene JF, MATSUMOTO LM, Gregoratos G, Hirst AE. Dissecting Aneurysm. JAMA. 1974;230(1):34. doi:10.1001/jama.1974.03240010018004
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