1. Tranexamic Acid and Pulmonary Complications: A Secondary Analysis of an EAST Multicenter Trial.
- Author
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Raza SS, Tatum D, Nordham KD, Broome JM, Keating J, Maher Z, Goldberg AJ, Chang G, Mendiola Pla M, Haut ER, Tatebe L, Toraih E, Anderson C, Ninokawa S, Maluso P, Burruss S, Reeves M, Coleman LE, Shatz DV, Goldenberg-Sandau A, Bhupathi A, Spalding C, LaRiccia A, Bird E, Noorbakhsh MR, Babowice J, Nelson MC, Jacobson LE, Williams J, Vella M, Dellonte K, Hayward TZ 3rd, Holler E, Lieser MJ, Berne JD, Mederos DR, Askari R, Okafor B, Etchill E, Fang R, Roche SL, Whittenburg L, Bernard AC, Haan JM, Lightwine KL, Norwood SH, Murry J, Gamber MA, Carrick MM, Bugaev N, Tatar A, Duchesne J, and Taghavi S
- Subjects
- Humans, Female, Male, Adult, Prospective Studies, Middle Aged, Pneumonia etiology, Pneumonia prevention & control, Pneumonia drug therapy, Respiratory Distress Syndrome etiology, Respiratory Distress Syndrome drug therapy, Respiratory Distress Syndrome prevention & control, Trauma Centers, Acute Lung Injury etiology, Acute Lung Injury drug therapy, Acute Lung Injury prevention & control, Tranexamic Acid therapeutic use, Tranexamic Acid administration & dosage, Antifibrinolytic Agents therapeutic use, Antifibrinolytic Agents administration & dosage, Wounds, Penetrating complications, Wounds, Penetrating mortality, Propensity Score
- 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., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
- Published
- 2025
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