# Obesity significantly elevates thromboembolism risk in severe trauma, yet essential resuscitation with TXA and erythrocytes remains safe

## TL;DR

Obese trauma patients have higher thromboembolism risk, but standard resuscitation with TXA and blood remains safe.

## Contribution

Identifies BMI as a strong predictor of thromboembolism in trauma patients and confirms safety of essential resuscitation in obese individuals.

## Key findings

- Higher BMI is the strongest independent predictor of post-traumatic thromboembolism.
- TXA and erythrocyte administration in obese trauma patients does not increase thromboembolism risk.
- Lower hemoglobin levels are observed in thromboembolism cases post-trauma.

## Abstract

Given obesity’s rising prevalence and its established role as an independent thromboembolic risk factor, potentially inducing a procoagulant state post-trauma, this study aimed to pinpoint key obesity-related factors influencing thromboembolic occurrences in this vulnerable patient group to guide interventions.

This retrospective study analyzed a consecutive cohort of 1547 trauma patients age ≥ 18 years with an Injury-Severity-Score (ISS) ≥ 9 admitted to our level I trauma center between 01/2018 and 12/2024. Patients’ data were extracted from electronic medical records. Exclusions included pregnancy, malignant/neurodegenerative disease, prior thromboembolism, and inconclusive documentation. Risk factors and influencing factors regarding obesity to suffer post-traumatic thromboembolism were evaluated.

Older age, higher Body Mass Index (BMI), and greater Injury Severity Score (ISS) (p < 0.05 for all) were identified as significant independent predictors, with BMI revealing the strongest effect (OR 1.077, p = 0.001). In the obese cohort (BMI ≥ 30), administration rates of tranexamic acid (TXA) and erythrocytes did not significantly differ between the TE and non-TE-groups (p > 0.05). Hemoglobin levels were significantly lower in the TE group at 0, 24 and 48 h post trauma (p < 0.05), while International Normalized Ratio (INR) and Partial Thromboplastin Time (aPTT) did not significantly differ.

Older patient age, higher BMI, and ISS are independent predictors of post-traumatic thromboembolism. Crucially, the administration of TXA and erythrocyte concentrates, essential for acute hemorrhage control, was not associated with an increased thromboembolic risk in the obese cohort. These findings support aggressive hemostatic resuscitation in high-risk obese patients.