Does Tranexamic Acid Cause Venous Thromboembolism After Trauma?

Etchill, Eric W.; Fang, Raymond; Haut, Elliott R.

doi:10.1001/jamasurg.2017.3855

Cited by 4 publications

(2 citation statements)

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“…33,34 Even if there is a small increased risk of VTE, TXA still may be of overall benefit if lives are saved. 35 Questions related to TXA were noted related not only to trauma patients but also to patients with burn injury. 36 As future studies define the role of TXA in the treatment of burn injury patients, studies will also need to define how this treatment alters VTE risk in these high-risk patients.…”

Section: Discussionmentioning

confidence: 99%

“…Some papers report no association between VTE and TXA administration, while others have found an increased rate of VTE in patients after TXA 33,34 . Even if there is a small increased risk of VTE, TXA still may be of overall benefit if lives are saved 35 . Questions related to TXA were noted related not only to trauma patients but also to patients with burn injury 36 .…”

Section: Discussionmentioning

confidence: 99%

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Research priorities in venous thromboembolism after trauma: Secondary analysis of the National Trauma Research Action Plan

Costantini

Bulger

Price

et al. 2023

J Trauma Acute Care Surg

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BACKGROUND Venous thromboembolism (VTE) is a significant cause of morbidity and mortality during recovery from injury and can result in significant health care costs. Despite advances in the past several decades in our approach to VTE prophylaxis after injury, opportunities exist to improve the delivery and implementation of optimal VTE prophylaxis. Here, we aim to identify consensus research questions related to VTE across all National Trauma Research Action Plan (NTRAP) Delphi expert panels to further guide the research agenda aimed at preventing VTE after injury. METHODS This is a secondary analysis of consensus-based research priorities that were collected using a Delphi methodology by 11 unique NTRAP panels that were charged with unique topic areas across the spectrum of injury care. The database of questions was queried for the keywords “VTE,” “venous thromboembo,” and “DVT” and then grouped into relevant topic areas. RESULTS There were 86 VTE-related research questions identified across 9 NTRAP panels. Eighty-five questions reached consensus with 24 rated high priority; 60, medium priority; and 1, low priority. Questions related to the timing of VTE prophylaxis (n = 17) were most common, followed by questions related to risk factors for the development of VTE (n = 16), the effects of tranexamic acid on VTE (n = 11), the approach to dosing of pharmacologic prophylaxis (n = 8), and the pharmacologic prophylactic medication choice for optimal VTE prophylaxis (n = 6). CONCLUSION National Trauma Research Action Plan panelists identified 85 consensus-based research questions that should drive dedicated extramural research funding opportunities to support quality studies aimed at optimizing VTE prophylaxis after injury. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Research priorities in venous thromboembolism after trauma: Secondary analysis of the National Trauma Research Action Plan

Costantini

Bulger

Price

et al. 2023

J Trauma Acute Care Surg

Self Cite

View full text Add to dashboard Cite

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Care of the Severely Injured Orthopedic Trauma Patient

Richards

Conti

Grissom

2018

Advances in Anesthesia

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Tranexamic acid administration is associated with an increased risk of posttraumatic venous thromboembolism

Myers

Kutcher

Rosengart

et al. 2019

J Trauma Acute Care Surg

164

127

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BACKGROUND Tranexamic acid (TXA) is used as a hemostatic adjunct for hemorrhage control in the injured patient and reduces early preventable death. However, the risk of venous thromboembolism (VTE) has been incompletely explored. Previous studies investigating the effect of TXA on VTE vary in their findings. We performed a propensity matched analysis to investigate the association between TXA and VTE following trauma, hypothesizing that TXA is an independent risk factor for VTE. METHODS This retrospective study queried trauma patients presenting to a single Level I trauma center from 2012 to 2016. Our primary outcome was composite pulmonary embolism or deep vein thrombosis. Mortality, transfusion, intensive care unit and hospital lengths of stay were secondary outcomes. Propensity matched mixed effects multivariate logistic regression was used to determine adjusted odds ratio (aOR) and 95% confidence intervals (95% CI) of TXA on outcomes of interest, adjusting for prespecified confounders. Competing risks regression assessed subdistribution hazard ratio of VTE after accounting for mortality. RESULTS Of 21,931 patients, 189 pairs were well matched across propensity score variables (standardized differences <0.2). Median Injury Severity Score was 19 (interquartile range, 12–27) and 14 (interquartile range, 8–22) in TXA and non-TXA groups, respectively (p = 0.19). Tranexamic acid was associated with more than threefold increase in the odds of VTE (aOR, 3.3; 95% CI, 1.3–9.1; p = 0.02). Tranexamic acid was not significantly associated with survival (aOR, 0.86; 95% CI, 0.23–3.25; p = 0.83). Risk of VTE remained elevated in the TXA cohort despite accounting for mortality (subdistribution hazard ratio, 2.42; 95% CI, 1.11–5.29; p = 0.03). CONCLUSION Tranexamic acid may be an independent risk factor for VTE. Future investigation is needed to identify which patients benefit most from TXA, especially given the risks of this intervention to allow a more individualized treatment approach that maximizes benefits and mitigates potential harms. LEVEL OF EVIDENCE Therapeutic, level III.

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Does Tranexamic Acid Cause Venous Thromboembolism After Trauma?

Abstract: collaborators. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial.

Cited by 4 publications

References 9 publications

Research priorities in venous thromboembolism after trauma: Secondary analysis of the National Trauma Research Action Plan

Research priorities in venous thromboembolism after trauma: Secondary analysis of the National Trauma Research Action Plan

Care of the Severely Injured Orthopedic Trauma Patient

Tranexamic acid administration is associated with an increased risk of posttraumatic venous thromboembolism

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