L. Rivas1, M. Vella8, J. Pascual8, G. Tortorello8, D. Turay9, J. Babcock9, A. Ratnasekera4, A. H. Warner6, D. R. Mederos5, J. Berne5, M. Mount2, T. Schroeppel7, M. Carrick3, B. Sarani1 1George Washington University School Of Medicine And Health Sciences,Surgery,Washington, DC, USA 2Spartanburg Medical Center,Surgery,Spartanburg, SC, USA 3Plano Medical Center,Surgery,Plano, TX, USA 4Crozier Keystone Medical Center,Surgery,Chester, PA, USA 5Broward Health Medical Center,Surgery,Fort Lauderdale, FL, USA 6Christiana Care Medical Center,Surgery,Newark, DE, USA 7University of Colorado Colorado Springs,Surgery,Colorado Springs, CO, USA 8University Of Pennsylvania,Surgery,Philadelphia, PA, USA 9Loma Linda University School Of Medicine,Surgery,Loma LInda, CA, USA
Introduction: Tranexamic acid (TXA) is an anti-fibrinolytic agent that lowers mortality of injured patients who are bleeding or at risk of bleeding. It is commonly used in trauma centers as an adjunct to massive transfusion protocols in the management of bleeding patients. But, its potent antifibrinolytic activity may result in an increased risk of venous thromboembolism (VTE). We hypothesized that the incidence of VTE events was greater in injured persons receiving TXA along with massive transfusion.
Methods: A multicenter, retrospective study was performed. Inclusion criteria were: age 18 years or older, patients who received 10 units or more of blood in the first 24 hours after injury. Exclusion criteria included: death within 24 hours, pregnancy, and routine ultrasound surveillance for possible asymptomatic deep venous thrombosis (DVT). Patients were divided in 2 cohorts based on whether or not they received TXA. Incidence of VTE was the primary outcome. Secondary outcomes included myocardial infarction (MI), stroke (CVA), and death. Multivariate logistic regression analysis was performed to control for demographic and clinically significant variables. A power analysis using expected DVT and PE rates based on prior studies found that a total of 830 patients were needed to find a statistically significant difference with a minimum power of 80%.
Results:269 patients fulfilled criteria; 124 (46%) of whom received TXA. No difference was noted in age (31 v 29, p=0.81), injury severity score (29 v 27, p=0.47), or mechanism of injury (62% penetrating v 61% blunt, p=0.81). Patients who received TXA had significantly lower systolic blood pressure on arrival (90 mmHg vs 107 mmHg, p=0.002). Incidence of VTE did not differ between the patients who received TXA and those who did not (DVT: 16% vs 13%, p=0.48 and PE 8% vs 6%, p=0.55). There was no difference in CVA or MI. There was no difference in mortality on multivariate analysis (OR 0.67, CI 0.30 – 1.12).
Conclusion:This preliminary report did not find an association between TXA and VTE or other prothrombotic complications. It remains to be seen if more subtle differences between groups will become manifest when the study accrual is complete.