Massive Transfusion Protocol and Subsequent Development of Venous Thromboembolism: Statewide Analysis

• Published in: The American surgeon Vol. 87; no. 1; pp. 15 - 20
• Main Authors: Bradburn, Eric H., Ho, Kwok M., Morgan, Madison E., D’Andrea, Lauren, Vernon, Tawnya M., Rogers, Frederick B.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.01.2021; SAGE PUBLICATIONS, INC
• Subjects: Adult; Age; Blood; Blood Transfusion; Blood transfusions; Clinical Protocols; Coagulation; Complications; Demographics; Demography; Embolism; Exsanguination - mortality; Exsanguination - therapy; Female; Glasgow Coma Scale; Hemorrhage; Humans; Incidence; Intensive care; Length of stay; Logistic Models; Male; Middle Aged; Patients; Pennsylvania; Prophylaxis; Pulmonary embolisms; Regression models; Retrospective Studies; Risk factors; Risk management; Survival; Thromboembolism; Thrombosis; Transfusion; Trauma; Trauma Centers; Venous Thromboembolism - epidemiology; Ventilators; Wounds and Injuries - complications; Wounds and Injuries - mortality; Wounds and Injuries - therapy; Pennsylvania; pulmonary embolism; massive transfusion; deep vein thrombosis
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/0003134820948905

Background Massive transfusion protocols (MTP) are a routine component of any major trauma center’s armamentarium in the management of exsanguinating hemorrhages. Little is known about the potential complications of those that survive a MTP. We sought to determine the incidence of venous thromboembolism (VTE) following MTP. We hypothesized that MTP would be associated with a higher risk of VTE when compared with a risk-adjusted control population without MTP. Methods The Pennsylvania Trauma Outcome Study database was retrospectively queried from 2015 to 2018 for trauma patients who developed VTE and survived until discharge at accredited trauma centers in Pennsylvania. Patient demographics, injury severity, and clinical outcomes were compared to assess differences in VTE development between MTP and non-MTP patients. A multivariate logistic regression model assessed the adjusted impact of MTP on VTE development. Results 176 010 patients survived until discharge, meeting inclusion criteria. Of those, 1667 developed a VTE (pulmonary embolism [PE]: 662 [0.4%]; deep vein thrombosis [DVT]: 1142 [0.6%]; PE and DVT: 137 [0.1%]). 1268 patients (0.7%) received MTP and, of this subset of patients, 171 (13.5%) developed a VTE during admission. In adjusted analysis, patients who had a MTP and survived until discharge had a higher odds of developing a VTE (adjusted odds ratio: 2.62; 95% CI: 2.13-3.24; P < .001). Discussion MTP is a harbinger for higher risk of VTE in those patients who survive. This may, in part, be related to the overcorrection of coagulation deficits encountered in the hemorrhagic event. A high index of suspicion for the development of VTE as well as aggressive VTE prophylaxis is warranted in those patients who survive MTP.