RS12. Comparing Mortality and Hospital Length of Stay in the Setting of Truncal and Peripheral Vascular Trauma in Patients Treated With Tranexamic Acid on Initial Presentation

Traumatic brain injury and hemorrhage are the leading causes of mortality in trauma. Nearly 70% of hemorrhagic shock results from truncal and peripheral vascular trauma. Historically, most data regarding vascular injuries resulting in hemorrhagic shock have been provided by military literature. There is a paucity of literature studying the effect of various resuscitative protocols in the setting of truncal and peripheral vascular trauma. Tranexamic acid (TXA) is an antifibrinolytic agent that has shown promise in improving survivability and reducing blood product transfusion requirement in cardiac surgery and trauma resuscitation. This study aimed to evaluate the safety and efficacy of early TXA use in a subgroup of patients who sustained truncal and peripheral vascular trauma with signs of traumatic hemorrhagic shock. This was a civilian hospital-based prospective, observational cohort study with a retrospective comparison at Arrowhead Regional Medical Center from 2015 to 2018. One cohort of patients received TXA on initial presentation; the control group consisted of patients with a similar Injury Severity Score (ISS) who did not receive TXA. Propensity score matching was conducted to select patients from the control group on the basis of age, sex, ISS, and mechanism of injury. The χ2 tests were conducted to identify differences in mortality and hospital length of stay (LOS) between the control and TXA groups. A total of 66 patients were included in the TXA group, and another matched 66 (of 87) patients were selected from the control group. A total of 132 patients were included in the final analysis. Propensity score matching demonstrated no statistically significant difference in age (P = .589), ISS (P = .649), blunt injury percentage (P = 1), or percentage of male patients (P = .804). Analysis of clinical outcomes demonstrated a reduction in mortality at 24 hours, 48 hours, and 28 days for the TXA group; however, those reductions in mortality did not reach statistical significance because of small sample size. In addition, the TXA group was associated with a statistically significant shorter hospital LOS (median of 12 days and 8 days for the control and TXA groups, respectively, P = .023). Our results demonstrate a trend toward decreased mortality at 24 hours, 48 hours, and 28 days for the TXA cohort. In addition, TXA administration significantly reduced hospital LOS. Although survival was not statistically significant in our study, the trend demonstrated warrants further study of TXA's use in vascular trauma with an appropriately powered sample size.