# Tranexamic acid in multiply injured patients–the independent risk of thromboembolic complications with repeated dosing: retrospective analysis based on the TraumaRegister DGU®

## TL;DR

This study shows that repeated doses of tranexamic acid in injured patients increase the risk of blood clots, suggesting caution with multiple administrations.

## Contribution

The study uniquely demonstrates an independent risk of thromboembolic complications with each repeated dose of tranexamic acid in multiply injured patients.

## Key findings

- 3.1% of patients receiving tranexamic acid experienced thromboembolic events, compared to 2.3% without treatment.
- Administering tranexamic acid two or three times was associated with 8.5% and 8.2% thromboembolic event rates, respectively.
- Multivariate analysis showed an increased odds ratio for thromboembolic complications with each additional dose of tranexamic acid.

## Abstract

Tranexamic acid is an established drug in the treatment of bleeding trauma patients. Concerns have been raised over possible complications of tranexamic acid regarding thromboembolic events as serious complications during the treatment of severely injured patients.

In our study we retrospectively analyzed data from 2015—2019 of multiply injured patients receiving tranexamic acid during distinguished treatment periods from the TraumaRegister DGU®. We statistically analyzed overall thromboembolic complications during hospital stay in the context of number of single-dose tranexamic acid administrations.

We report on 37,342 patients, of whom 1,151 (3.1%) suffered from thromboembolic events. Patients without tranexamic acid treatment suffered from thromboembolic events in 2.3%, prehospital and emergency department administration increased the incidence to 4.8% and 5.2%, respectively. Administering tranexamic acid twice or three times was associated with an increased incidence of 8.5% and 8.2%, respectively. In a multivariate logistic regression, we uniquely show an independently associated risk for thromboembolic complications with every consecutive administration of tranexamic acid (one application: odds ratio (OR) 1.56, p < 0.001; two applications: OR 1.79, p < 0.001; three applications: OR 1.50, p = 0.113).

In our study we report on an associated risk of thromboembolic events in multiply injured patients with every single time tranexamic acid was administered in our study. Thus, before a repetitive dose of tranexamic acid is administered checking for indication is advised and especially in multiply injured patients receiving repeated administrations of TXA starting a thromboprophylaxis, as soon as possible after the traumatic bleeding disorder is controlled, is important.