University of Texas Health Science Center at San Antonio, Department of Trauma and Emergency Surgery, San Antonio, TX, USA.
University of Texas Health Science Center at San Antonio, Department of Trauma and Emergency Surgery, San Antonio, TX, USA.
Am J Surg. 2024 Dec;238:115931. doi: 10.1016/j.amjsurg.2024.115931. Epub 2024 Aug 28.
Previous studies have demonstrated the benefits of tranexamic acid (TXA) administration in combination with packed red blood cell (PRBC) transfusion in trauma patients without increasing the risk of venous thromboembolism (VTE). However, the effect of TXA in combination with whole blood (WB) has not been studied. Injury, abbreviated injury severity scores (ISS and AIS) and the need for blood transfusions are historically associated with VTE. The objective of this study was to determine the relationship between VTE and the combination of TXA administration and transfusion of PRBCs vs. WB.
Our institutional trauma registry was queried for trauma patients between 2015 and 2022 who received either WB + TXA or PRBC + TXA either prehospital or within 4 h of arrival. Multivariate analysis was utilized to determine independent risk factors for VTE, which were defined as either a deep vein thrombosis (DVT) or a pulmonary embolism (PE). Model covariates included age, mechanism of injury (MOI), ISS, lower extremity AIS, comorbid conditions, and shock index (SI). Additional outcomes analyzed were hospital length of stay (LOS), ICU LOS, and ventilator days.
Three hundred and five patients had complete data and were included in the analysis. Of those, 251 received WB + TXA and 54 received PRBC + TXA. A total of 34 patients were found to have VTE event (11.1 %); 28 (11.2 %) and 6 (11.1 %) from the WB + TXA and PRBC + TXA groups, respectively. An elevated pre-hospital SI was independently associated with increased VTE rate (OR 1.85, 95 % CI 1.07-3.20). WB transfusion, TXA administration, ISS, and MOI did not influence the rate of VTE.
These data demonstrate that the combination of WB + TXA administered to trauma patients has no higher risk of VTE than patients who receive PRBC + TXA, a comparison that has not been studied clinically to date. Despite the pro thrombotic state enhanced by TXA and the decreased dilutional coagulopathy seen in WB resuscitation, there was no increased risk of VTE compared to TXA + PRBC. There is no evidence that TXA combined with whole blood transfusion is associated with an increased risk of VTE. However, higher pre-hospital SI was associated with an elevated rate of VTE. These clinical features provide insight into patients who may be at an increased risk of developing VTE and may benefit from targeted prevention strategies.
先前的研究表明，在创伤患者中，氨甲环酸（TXA）联合浓缩红细胞（PRBC）输血的益处，且不会增加静脉血栓栓塞（VTE）的风险。然而，TXA 联合全血（WB）的效果尚未得到研究。损伤、损伤严重程度评分（ISS 和 AIS）和输血需求与 VTE 有历史关联。本研究的目的是确定 TXA 给药联合 PRBC 输血与 WB 输血与 VTE 之间的关系。
我们的机构创伤登记处查询了 2015 年至 2022 年间接受 WB+TXA 或 PRBC+TXA 治疗的创伤患者，这些治疗在院前或入院后 4 小时内进行。多变量分析用于确定 VTE 的独立危险因素，VTE 定义为深静脉血栓形成（DVT）或肺栓塞（PE）。模型协变量包括年龄、损伤机制（MOI）、ISS、下肢 AIS、合并症和休克指数（SI）。分析的其他结果包括住院时间（LOS）、重症监护病房 LOS 和呼吸机使用天数。
305 名患者具有完整数据并纳入分析。其中，251 名患者接受了 WB+TXA，54 名患者接受了 PRBC+TXA。共有 34 名患者发生 VTE 事件（11.1%）；分别有 28 名（11.2%）和 6 名（11.1%）来自 WB+TXA 和 PRBC+TXA 组。院前升高的 SI 与增加的 VTE 发生率独立相关（OR 1.85，95%CI 1.07-3.20）。WB 输血、TXA 给药、ISS 和 MOI 并未影响 VTE 发生率。
这些数据表明，与接受 PRBC+TXA 的患者相比，创伤患者接受 WB+TXA 联合治疗不会增加 VTE 的风险，目前尚未对此进行临床比较。尽管 TXA 增强了血栓形成倾向，WB 复苏导致稀释性凝血障碍减轻，但与 TXA+PRBC 相比，VTE 的风险并未增加。没有证据表明 TXA 联合全血输血会增加 VTE 的风险。然而，院前较高的 SI 与 VTE 发生率升高相关。这些临床特征为可能处于更高 VTE 风险的患者提供了深入了解，并可能受益于有针对性的预防策略。
