Tranexamic Acid and Pulmonary Complications: A Secondary Analysis of an EAST Multicenter Trial

Shariq S Raza¹, Danielle Tatum², Kristen D Nordham^{2

3}, Jacob M Broome^{2

4}, Jane Keating¹, Zoe Maher⁵, Amy J Goldberg⁵, Grace Chang⁶, Michelle Mendiola Pla⁶, Elliott R Haut⁷, Leah Tatebe⁸, Eman Toraih², Christofer Anderson^{2

9}, Scott Ninokawa^{2

10}, Patrick Maluso¹¹, Sigrid Burruss¹², Matthew Reeves¹², Lauren E Coleman¹³, David V Shatz¹³, Anna Goldenberg-Sandau¹⁴, Apoorva Bhupathi¹⁴, Chance Spalding¹⁵, Aimee LaRiccia¹⁵, Emily Bird¹⁶, Matthew R Noorbakhsh¹⁷, James Babowice¹⁷, Marsha C Nelson¹⁸, Lewis E Jacobson¹⁹, Jamie Williams¹⁹, Michael Vella²⁰, Kate Dellonte²⁰, Thomas Z Hayward 3rd²¹, Emma Holler²¹, Mark J Lieser²², John D Berne²³, Dalier R Mederos²³, Reza Askari²⁴, Barbara Okafor²⁴, Eric Etchill⁷, Raymond Fang²⁵, Samantha L Roche²⁵, Laura Whittenburg²⁶, Andrew C Bernard²⁶, James M Haan²⁷, Kelly L Lightwine²⁷, Scott H Norwood²⁸, Jason Murry²⁸, Mark A Gamber²⁹, Matthew M Carrick²⁹, Nikolay Bugaev³⁰, Antony Tatar³⁰, Juan Duchesne², Sharven Taghavi²

Affiliations

¹ Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
² Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
³ Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA.
⁴ Department of Surgery, Medstar Georgetown Washington Hospital Center, Washington, DC, USA.
⁵ Department of Surgery, Temple University Hospital, Philadelphia, PA, USA.
⁶ Department of Surgery, Mount Sinai Hospital, Chicago, IL, USA.
⁷ Department of Surgery, School of Medicine, The Johns Hopkins University, Baltimore, MD, USA.
⁸ Department of Surgery, Northwestern University School of Medicine, Chicago, IL, USA.
⁹ Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
¹⁰ Department of Emergency Medicine, University of California San Diego, San Diego, CA USA.
¹¹ Department of Surgery, Cook County Health, Chicago, IL, USA.
¹² Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA.
¹³ Department of Surgery, Medical Center, University of California Davis, Sacramento, CA, USA.
¹⁴ Department of Surgery, Cooper University Hospital, Camden, NJ, USA.
¹⁵ Department of Surgery, Grant Medical Center, Columbus, OH, USA.
¹⁶ Department of Surgery, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, USA.
¹⁷ Department of Surgery, Allegheny General Hospital, Pittsburgh, PA, USA.
¹⁸ Department of Surgery, Cape Fear Valley Hospital, Fayetteville, NC, USA.
¹⁹ Department of Surgery, Ascension St. Vincent Hospital, Indianapolis, IN, USA.
²⁰ Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
²¹ Department of Surgery, Sydney & Lois Eskanzi Hospital (Smith Level I Shock Trauma), Indianapolis, IN, USA.
²² Department of Surgery, Research Medical Center, Kansas City, MO, USA.
²³ Department of Surgery, Broward HealthMedical Center, Ft Lauderdale, FL, USA.
²⁴ Department of Surgery, Brigham & Women's Hospital, Boston, MA, USA.
²⁵ Department of Surgery, Bayview Medical Center, Johns Hopkins, Baltimore, MA, USA.
²⁶ Department of Surgery, University of Kentucky, Lexington, KY, USA.
²⁷ Department of Surgery, Ascension Via Christi Hospital St Francis, Wichita, KS, USA.
²⁸ Department of Surgery, University of Texas Health, Tyler, TX, USA.
²⁹ Department of Surgery, Medical City Plano, Plano, TX, USA.
³⁰ Department of Surgery, Tufts Medical Center, Boston, MA, USA.

PMID: 39110880
DOI: 10.1177/00031348241268109

Observational Study

Tranexamic Acid and Pulmonary Complications: A Secondary Analysis of an EAST Multicenter Trial

Shariq S Raza et al. Am Surg. 2025 Jan.

. 2025 Jan;91(1):107-114.

doi: 10.1177/00031348241268109. Epub 2024 Aug 7.

Authors

Affiliations

¹ Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
² Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
³ Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA.
⁴ Department of Surgery, Medstar Georgetown Washington Hospital Center, Washington, DC, USA.
⁵ Department of Surgery, Temple University Hospital, Philadelphia, PA, USA.
⁶ Department of Surgery, Mount Sinai Hospital, Chicago, IL, USA.
⁷ Department of Surgery, School of Medicine, The Johns Hopkins University, Baltimore, MD, USA.
⁸ Department of Surgery, Northwestern University School of Medicine, Chicago, IL, USA.
⁹ Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
¹⁰ Department of Emergency Medicine, University of California San Diego, San Diego, CA USA.
¹¹ Department of Surgery, Cook County Health, Chicago, IL, USA.
¹² Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA.
¹³ Department of Surgery, Medical Center, University of California Davis, Sacramento, CA, USA.
¹⁴ Department of Surgery, Cooper University Hospital, Camden, NJ, USA.
¹⁵ Department of Surgery, Grant Medical Center, Columbus, OH, USA.
¹⁶ Department of Surgery, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, USA.
¹⁷ Department of Surgery, Allegheny General Hospital, Pittsburgh, PA, USA.
¹⁸ Department of Surgery, Cape Fear Valley Hospital, Fayetteville, NC, USA.
¹⁹ Department of Surgery, Ascension St. Vincent Hospital, Indianapolis, IN, USA.
²⁰ Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
²¹ Department of Surgery, Sydney & Lois Eskanzi Hospital (Smith Level I Shock Trauma), Indianapolis, IN, USA.
²² Department of Surgery, Research Medical Center, Kansas City, MO, USA.
²³ Department of Surgery, Broward HealthMedical Center, Ft Lauderdale, FL, USA.
²⁴ Department of Surgery, Brigham & Women's Hospital, Boston, MA, USA.
²⁵ Department of Surgery, Bayview Medical Center, Johns Hopkins, Baltimore, MA, USA.
²⁶ Department of Surgery, University of Kentucky, Lexington, KY, USA.
²⁷ Department of Surgery, Ascension Via Christi Hospital St Francis, Wichita, KS, USA.
²⁸ Department of Surgery, University of Texas Health, Tyler, TX, USA.
²⁹ Department of Surgery, Medical City Plano, Plano, TX, USA.
³⁰ Department of Surgery, Tufts Medical Center, Boston, MA, USA.

PMID: 39110880
DOI: 10.1177/00031348241268109

Abstract

Background: Anti-inflammatory effects of tranexamic acid (TXA) in reducing trauma endotheliopathy may protect from acute lung injury. Clinical data showing this benefit in trauma patients is lacking. We hypothesized that TXA administration mitigates pulmonary complications in penetrating trauma patients.

Materials and methods: This is a post-hoc analysis of a multicenter, prospective, observational study of adults (18+ years) with penetrating torso and/or proximal extremity injury presenting at 25 urban trauma centers. Tranexamic acid administration in the prehospital setting or within three hours of admission was examined. Participants were propensity matched to compare similarly injured patients. The primary outcome was development of pulmonary complication (ARDS and/or pneumonia).

Results: A total of 2382 patients were included, and 206 (8.6%) received TXA. Of the 206, 93 (45%) received TXA prehospital and 113 (55%) received it within three hours of hospital admission. Age, sex, and incidence of massive transfusion did not differ. The TXA group was more severely injured, more frequently presented in shock (SBP < 90 mmHg), developed more pulmonary complications, and had lower survival (P < 0.01 for all). After propensity matching, 410 patients remained (205 in each cohort) with no difference in age, sex, or rate of shock. On logistic regression, increased emergency department heart rate was associated with pulmonary complications. Tranexamic acid was not associated with different rate of pulmonary complications or survival on logistic regression. Survival was not different between the groups on logistic regression or propensity score-matched analysis.

Conclusions: Tranexamic acid administration is not protective against pulmonary complications in penetrating trauma patients.

Keywords: ARDS; Penetating trauma; TXA; Tranexamic acid; pneumonia; pulmonary complications.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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Tranexamic Acid and Pulmonary Complications: A Secondary Analysis of an EAST Multicenter Trial

Affiliations

Tranexamic Acid and Pulmonary Complications: A Secondary Analysis of an EAST Multicenter Trial

Authors

Affiliations

Abstract

Conflict of interest statement

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LinkOut - more resources

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