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Observational Study
. 2024 Apr 1;96(4):596-602.
doi: 10.1097/TA.0000000000004227. Epub 2023 Dec 8.

Tranexamic acid is not associated with a higher rate of thrombotic-related reintervention after major vascular injury repair

Sina Asaadi  1 , Kaushik Mukherjee, Ahmed M Abou-Zamzam, Liang Ji, Xian Luo-Owen, Maryam B Tabrizi, Richard D Catalano, Joseph J Dubose, Martin G Rosenthal; AAST PROOVIT Study Group
Affiliations
Observational Study

Tranexamic acid is not associated with a higher rate of thrombotic-related reintervention after major vascular injury repair

Sina Asaadi et al. J Trauma Acute Care Surg. .

Abstract

Background: Tranexamic acid (TXA) is associated with lower mortality and transfusion requirements in trauma patients, but its role in thrombotic complications associated with vascular repairs remains unclear. We investigated whether TXA increases the risk of thrombosis-related technical failure (TRTF) in major vascular injuries (MVI).

Methods: The PROspective Observational Vascular Injury Treatment (PROOVIT) registry was queried from 2013 to 2022 for MVI repaired with an open or endovascular intervention. The relationship between TXA administration and TRTF was examined.

Results: The TXA group (n = 297) had higher rates of hypotension at admission (33.6% vs. 11.5%, p < 0.001), need for continuous vasopressors (41.4% vs. 18.4%, p < 0.001), and packed red blood cell transfusion (3.2 vs. 2.0 units, p < 0.001) during the first 24 hours compared with the non-TXA group (n = 1941), although demographics, injury pattern, and interventions were similar. Cryoprecipitate (9.1% vs. 2%, p < 0.001), and anticoagulant administration during the intervention (32.7% vs. 43.8%, p < 0.001) were higher in the TXA group; there was no difference in the rate of factor VII use between groups (1% vs. 0.7%, p = 0.485). Thrombosis-related technical failure was not different between the groups (6.3% vs. 3.8 p = 0.141) while the rate of immediate need for reoperation (10.1% vs. 5.7%, p = 0.006) and overall reoperation (11.4% vs. 7%, p = 0.009) was significantly higher in the TXA group on univariate analysis. There was no significant association between TXA and a higher rate of immediate need for reintervention (odds ratio [OR], 1.19; 95% confidence interval [CI], 0.75-1.88; p = 0.465), overall reoperation rate (OR, 1.33; 95% CI, 0.82-2.17; p = 0.249) and thrombotic events in a repaired vessel (OR, 1.07; 95% CI, 0.60-1.92; p = 0.806) after adjusting for type of injury, vasopressor infusions, blood product and anticoagulant administration, and hemodynamics.

Conclusion: Tranexamic acid is not associated with a higher risk of thrombosis-related technical failure in traumatic injuries requiring major vascular repairs. Further prospective studies to examine dose-dependent or time-dependent associations between TXA and thrombotic events in MVIs are needed.

Level of evidence: Therapeutic/Care Management; Level IV.

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References

    1. Wong J, George RB, Hanley CM, Saliba C, Yee DA, Jerath A. Tranexamic acid: current use in obstetrics, major orthopedic, and trauma surgery. Can J Anaesth . 2021;68(6):894–917.
    1. July J, Pranata R. Tranexamic acid is associated with reduced mortality, hemorrhagic expansion, and vascular occlusive events in traumatic brain injury—meta-analysis of randomized controlled trials. BMC Neurol . 2020;20(1):119.
    1. Ackerman RS, Hirschi M, Trona N, Joyce DM, Evans T, Patel SY. Incidence of thromboembolic events in oncology patients receiving intraoperative tranexamic acid during orthopedic surgery: a retrospective review at a comprehensive cancer center. A A Pract . 2020;14(2):63–66.
    1. Karl V, Thorn S, Mathes T, Hess S, Maegele M. Association of Tranexamic Acid Administration with Mortality and Thromboembolic Events in patients with traumatic injury: a systematic review and Meta-analysis. JAMA Netw Open . 2022;5(3):e220625.
    1. Madsen RV, Nielsen CS, Kallemose T, Husted H, Troelsen A. Low risk of thromboembolic events after routine administration of tranexamic acid in hip and knee arthroplasty. J Arthroplasty . 2017;32(4):1298–1303.

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