K. Kelliher1, P. Kyros1, C. Falank1, L. Cattin1, D. Cullinane1, F. Sheppard1 1MaineHealth Maine Medical Center, Portland, ME, USA
Introduction: Hemorrhage remains the leading cause of preventable death in trauma. The early empiric administration of tranexamic acid (TXA) has been shown to decrease mortality in trauma. However, studies have reported an increase in venous thromboembolic complications in patients receiving TXA. Recent studies have reported use of TXA in elderly patients with hip fractures without increased incidence of deep vein thromboses (DVTs). The benefits of empiric use of TXA in geriatric trauma patients remains to be elucidated. In our investigation, we sought to determine the impact of empiric TXA administration in geriatric trauma patients with respect to mortality, blood product use, and incidence of DVT and pulmonary embolism (PE).
Methods: A retrospective 10.5-year review of a single rural level 1 trauma center registry was performed. Patients ≥ 65 years of age who received early empiric TXA between January 1, 2014 and July 30, 2024, were included. A matched cohort for Injury Severity Score (ISS), Abbreviated Injury Scale (AIS), gender, age and who received ³ 1 unit of blood product control group was identified and used in a 2:1 (no TXA: TXA) paired case-control study. Statistics were performed using Fisher’s exact test and chi-squared test with p<0.05 for significance.
Results: Twenty-one patients received empiric TXA met inclusion criteria. There was no difference in the TXA cohort and the matched cohort for age (78 ± 7.1; 78.6 ± 8.4), ISS (18.5 ± 11.5; 17 ± 7.5), AIS head (3 ±1.6; 3. ± 1.3), AIS thorax (2.5 ± 0.9; 2.6 ± 0.8), AIS abdomen (2.9 ± 1.2; 2.4 ± 1.3); AIS spine (2.25 ± 0.7; 2.25 ± 0.4); and lower extremity AIS (2.25 ± 0.9; 2.15 ± 0.9). Mortality was the same in both groups (19%) and there was no significant difference in DVT/PE (0.33, p<0.05), or blood product transfusions.
Conclusion: In this single rural level 1 trauma center our 10.5 yr retrospective cohort study did not demonstrate an increase in mortality, DVT, PE, or blood product use with empiric TXA use in geriatric trauma. Our trauma center serves a state with the oldest per capita population in the United States, and it is surprising that relatively few geriatric trauma patients received TXA empirically. The results of our study are encouraging regarding TXA’s safety profile in this population, but definitive conclusions cannot be made. Our study was limited by the number enrolled and the matched retrospective cohort methodology. Further clarification and studies of the use of TXA in geriatric trauma is warranted and would likely require multicenter collaboration.