2020 Trauma/Critical Care Presentations

Elissa Beebe, Elissa Beebe, Capt, USAF, DSc, PA-C; Brooke Army Medical Center

Background: Despite the fact that uncontrolled post-traumatic hemorrhage is one of the most preventable causes of death after severe trauma, it remains a leading cause of mortality worldwide. To aid in the prevention of fatal hemorrhage, the use of Tranexamic Acid (TXA) use has become increasingly prevalent. Current literature supports the use of TXA in patients with traumatic hemorrhage but has also demonstrated an increased incidence of venous thromboembolisms (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), with the administration of TXA. However, this literature is limited in analyzing VTE incidence within the first 30 days of TXA administration only. We sought to determine if TXA use in acute hemorrhagic trauma increased the incidence of thromboembolic events in active duty service members beyond the 30-day mark and up to one year after the initial trauma (Spahn, Bouillon, & Cerny et al, 2013).

Methods: A retrospective cohort study of data from the Department of Defense Trauma Registry (DoDTR) was used to identify all US military injured in Operation Enduring Freedom (OEF) from January 1, 2009 through December 31, 2014 with an Injury Severity Score (ISS) of 10 or more, who received a massive transfusion (10 or more units of blood) within 24hrs. Those who met inclusion criteria were evaluated using univariate analysis to determine factors associated with venous thromboembolisms (VTE).

Results: Our data revealed an increase in VTE in those who received TXA (24%) versus no TXA (21%), but was not statistically significant, χ2 (1, N = 641) = 0.43, p = 0.5125. TXA administration compared to major complications was also not statistically significant, χ2 (1, N = 641) = 0.22, p = 0.6406.

Conclusion: In our population, we found no significant increase in VTE or other major complications 30 days to one year following the administration of TXA. Thus, its continued use is warranted due to TXA’s proven survival benefit in combat casualties. Recommendations against the use of TXA in this population cannot be made on the basis of increased risk of thromboembolic events alone.

Key Words: trauma, surgery, military, Tranexamic Acid, massive transfusion, hemorrhage, thromboembolic, pulmonary embolism, deep vein thrombosis, TXA, PE, DVT