Tranexamic Acid and Pulmonary Complications: A Secondary Analysis of an EAST Multicenter Trial-Reference-Cited by-同舟云学术

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

Published:2024-08-07 Issue: Volume: Page:
ISSN:0003-1348
Container-title:The American Surgeon™
language:en
Short-container-title:The American Surgeon™

Author:

Raza Shariq S.¹,Tatum Danielle²,Nordham Kristen D.²³,Broome Jacob M.²⁴,Keating Jane¹,Maher Zoe⁵,Goldberg Amy J.⁵,Chang Grace⁶,Mendiola Pla Michelle⁶,Haut Elliott R.⁷,Tatebe Leah⁸,Toraih Eman²,Anderson Christofer²⁹^ORCID,Ninokawa Scott²¹⁰,Maluso Patrick¹¹^ORCID,Burruss Sigrid¹²,Reeves Matthew¹²,Coleman Lauren E.¹³,Shatz David V.¹³,Goldenberg-Sandau Anna¹⁴,Bhupathi Apoorva¹⁴,Spalding Chance¹⁵,LaRiccia Aimee¹⁵,Bird Emily¹⁶,Noorbakhsh Matthew R.¹⁷,Babowice James¹⁷,Nelson Marsha C.¹⁸,Jacobson Lewis E.¹⁹,Williams Jamie¹⁹,Vella Michael²⁰,Dellonte Kate²⁰,Hayward Thomas Z.²¹,Holler Emma²¹,Lieser Mark J.²²,Berne John D.²³,Mederos Dalier R.²³,Askari Reza²⁴,Okafor Barbara²⁴,Etchill Eric⁷,Fang Raymond²⁵,Roche Samantha L.²⁵,Whittenburg Laura²⁶,Bernard Andrew C.²⁶,Haan James M.²⁷,Lightwine Kelly L.²⁷,Norwood Scott H.²⁸,Murry Jason²⁸,Gamber Mark A.²⁹,Carrick Matthew M.²⁹,Bugaev Nikolay³⁰,Tatar Antony³⁰,Duchesne Juan²,Taghavi Sharven²

Affiliation:

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

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.

Publisher

SAGE Publications

Link

https://journals.sagepub.com/doi/pdf/10.1177/00031348241268109

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