R. B. Bashir1, A. Grigorian1, D. Spencer1, J. L. Phillips1, B. J. Hasjim1, S. Albertson1, C. Figueroa1, M. Lekawa1, J. Nahmias1 1University Of California – Irvine,Department Of Surgery,Orange, CA, USA
Introduction: Alcohol can impair hemostasis, decreasing the risk of venous thromboembolism (VTE). However, a previous report demonstrated that a significantly elevated blood alcohol concentration (BAC) was associated with an increased risk of VTE. This may suggest an inflection threshold where BAC transitions patients from a hypocoagulable to hypercoagulable state. Therefore, compared to patients with negative BAC on admission, we hypothesized that trauma patients with severely elevated BAC levels are at higher risk for VTE while patients with moderate BAC level are at lower risk.
Methods: We performed a retrospective cohort study of trauma patients ≥18 years admitted between 2010 and 2017 to a single Level-I trauma center. Patients were grouped based on known BAC: negative (0 mg/dL), moderate (1-80 mg/dL), and severe (>80 mg/dL). The primary outcome was the rate of VTE, including pulmonary embolism (PE) and deep vein thrombosis (DVT). Secondary endpoints included mortality and overall length of stay (LOS). We performed a chi-square analysis.
Results: From 18,798 trauma admissions, 13,624 (72.5%) had a negative BAC, 1,207 (6.4%) presented with moderate BAC and 3,967 (21.2%) had severe BAC. Compared to the negative and severe BAC groups, those that had a moderate BAC level had a higher median Injury Severity Score (5 vs. 2 vs. 4, p<0.001) but no significant difference in LOS (p=0.44). The severe BAC group had a lower mortality rate compared to the negative and moderate BAC group (1.8% vs. 2.7% vs. 2.7%, p=0.004). The overall incidence of VTE in this population was remarkably low (0.18%) and did not significantly deviate between BAC groups (p=0.41).
Conclusion: In a single Level-I trauma center, there was no difference in the rate of VTE or LOS between trauma patients with negative, moderate, and severe BAC levels. Surprisingly, patients with severe BAC had the lowest rate of mortality. Future basic science research investigating the differences in clotting factors and biochemical sequela after varying levels of BAC is warranted.
