Department of Intensive Care, Amsterdam University Medical Centers, location Academic Medical Centre, Amsterdam, The Netherlands.
Trauma Unit, Department of Surgery, Amsterdam University Medical Centers, location Academic Medical Centre, Amsterdam, The Netherlands.
Transfusion. 2020 Aug;60(8):1873-1882. doi: 10.1111/trf.15917. Epub 2020 Jun 24.
Transfusion therapy in hemorrhaging trauma patients is associated with the development of thromboembolic events. It is unknown whether current resuscitation strategies, including large volumes of plasma and early administration of procoagulant therapy, increases this risk.
A systematic search was conducted in MEDLINE, PubMed, and Embase. Studies were screened by two independent reviewers and included if they reported on thromboembolic events in patients with severe trauma (injury severity score ≥16) who received transfusion of at least 1 unit of red blood cells. The ratio by which blood products were transfused, as well as use of procoagulant or antifibrinolytic medication, was recorded.
A total of 40 studies with 11.074 bleeding trauma patients were included, in which 1.145 thromboembolic events were reported, yielding an incidence of 10% thromboembolic events. In studies performing routine screening for thromboembolic complications, the incidence ranged from 12% to 23%. The risk of thromboembolic events was increased after administration of tranexamic acid (TXA; odds ratio [OR], 2.6; 95% confidence interval [CI], 1.7-4.1; p < 0.001) and fibrinogen concentrate (OR, 2.1; 95% CI, 1.0-4.2; p = 0.04). Blood product ratio, the use of prothrombin complex concentrate or recombinant factor VIIa were not associated with thromboembolic events.
This systematic review identified an incidence of thromboembolic events of 10% in severely injured bleeding trauma patients. The use of TXA and fibrinogen concentrate was associated with the development of thromboembolic complications.
出血性创伤患者的输血治疗与血栓栓塞事件的发生有关。目前尚不清楚当前的复苏策略（包括大量的血浆和早期应用促凝治疗）是否会增加这种风险。
在 MEDLINE、PubMed 和 Embase 中进行了系统检索。如果研究报告了严重创伤（损伤严重程度评分≥16）患者输血至少 1 单位红细胞后发生血栓栓塞事件，则筛选出研究。记录血液制品的输注比例，以及促凝或抗纤维蛋白溶解药物的使用情况。
共纳入 40 项研究，涉及 11074 例出血性创伤患者，其中 1145 例报告了血栓栓塞事件，发生率为 10%的血栓栓塞事件。在进行常规血栓栓塞并发症筛查的研究中，发生率范围为 12%至 23%。使用氨甲环酸（TXA；优势比[OR]，2.6；95%置信区间[CI]，1.7-4.1；p<0.001）和纤维蛋白原浓缩物（OR，2.1；95%CI，1.0-4.2；p=0.04）可增加血栓栓塞事件的风险。血液制品比例、使用凝血酶原复合物浓缩物或重组因子 VIIa 与血栓栓塞事件无关。
本系统评价确定了严重受伤出血性创伤患者中血栓栓塞事件的发生率为 10%。使用氨甲环酸和纤维蛋白原浓缩物与血栓栓塞并发症的发生有关。
