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

Shariq S. Raza, Danielle Tatum, Kristen D. Nordham, Jacob M. Broome, Jane Keating, Zoe Maher, Amy J. Goldberg, Grace Chang, Michelle Mendiola Pla, Elliott R. Haut, Leah Tatebe, Eman Toraih, Christofer Anderson, Scott Ninokawa, Patrick Maluso, Sigrid Burruss, Matthew Reeves, Lauren E. Coleman, David V. Shatz, Anna Goldenberg-SandauApoorva Bhupathi, Chance Spalding, Aimee LaRiccia, Emily Bird, Matthew R. Noorbakhsh, James Babowice, Marsha C. Nelson, Lewis E. Jacobson, Jamie Williams, Michael Vella, Kate Dellonte, Thomas Z. Hayward, Emma Holler, Mark J. Lieser, John D. Berne, Dalier R. Mederos, Reza Askari, Barbara Okafor, Eric Etchill, Raymond Fang, Samantha L. Roche, Laura Whittenburg, Andrew C. Bernard, James M. Haan, Kelly L. Lightwine, Scott H. Norwood, Jason Murry, Mark A. Gamber, Matthew M. Carrick, Nikolay Bugaev, Antony Tatar, Juan Duchesne, Sharven Taghavi

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)107-114
Number of pages8
JournalThe American surgeon
Volume91
Issue number1
DOIs
StatePublished - Jan 1 2025

Keywords

  • ARDS
  • Penetating trauma
  • pneumonia
  • pulmonary complications
  • Tranexamic acid
  • TXA

ASJC Scopus subject areas

  • Surgery

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