A. D. Dure1, R. M. Antar1, A. I. Halpern1, M. Gaddam2, C. M. Rivera1, S. Kartiko1 2The George Washington University, Washington, DC, USA 1George Washington University School Of Medicine And Health Sciences, Surgery, Washington, DC, USA
Introduction:
Trauma patients experience physiological distress, leading to an impaired adaptive immune response and an increased susceptibility to infections. Tranexamic Acid (TXA) has shown potential as an immune modulator by decreasing levels of IL-10 and altering the immunophenotype of phagocytes. Its use has been associated with lower postoperative infection rates in orthopedic and cardiac surgery. Preliminary studies conducted in civilian trauma patients suggest a potential increased risk of infection with TXA. Conversely, a study conducted on a military population with life-threatening injuries did not find TXA to be a risk factor for infections. Our study aims to clarify the relationship between TXA administration and infection rates among trauma patients.
Methods:
A retrospective review of 364 adult trauma patients with mass transfusion protocol (MTP) activation was conducted at a level one trauma center between 2016 and 2023, assessing two cohorts: those who received TXA (n=61) and those who did not (n=303). Infections were defined as a positive diagnosis of catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), osteomyelitis, severe sepsis, surgical site infection, or ventilator-acquired pneumonia. Univariate and multivariate analyses were performed to identify variables associated with infection. Two-sided nonparametric Mann-Whitney U and Chi-Squared tests compared various factors between TXA and non-TXA groups. Given our modest sample size, we used 1:1 propensity score matching to strengthen our analysis.
Results:
On univariate analysis, infection rates for the non-TXA and TXA groups were significantly different at 7.9% and 19.7%, respectively (p=0.007). The most common infections for the non-TXA and TXA groups were surgical site infections, with respective rates of 4.6% and 9.8%. However, on multivariate analysis after propensity score matching, the association between TXA and infection was no longer significant (p=0.902); of note, total hospital and ventilator days were both associated with infection (p=0.01, p=0.021).
Conclusion:
Our findings indicate that TXA is neither a risk factor nor protective against infections in adult trauma patients when MTP is activated. Further studies with a larger patient population are needed to solidify these results and clarify the association between TXA and infection in trauma patients.
