Whole Blood Resuscitation Reduces Venous Thromboembolism Risk: New Insights for Trauma Care

Study presented at the 2024 Annual Scientific Assembly of the Eastern Association for the Surgery of Trauma reveals significant benefits of whole blood (WB) resuscitation in trauma patients

In a breakthrough study presented at the 2024 Annual Scientific Assembly of the Eastern Association for the Surgery of Trauma, researchers have shed light on the potential advantages of whole blood (WB) resuscitation in trauma care, specifically in mitigating the risk of venous thromboembolism (VTE). Lead author Brittany Hout, PA-C, from the U.S. Navy in Coronado, California, highlighted the implications of their findings, suggesting that WB could emerge as the preferred strategy for resuscitating bleeding trauma patients.

Understanding the Study

The multi-institutional retrospective study focused on assessing how different resuscitation strategies affect VTE risk among trauma patients admitted to two American College of Surgeons Level I trauma centers. Spanning from January 2016 to December 2021, the study included patients aged over 15 years who received at least one unit of emergency-release blood product. The cohort comprised 3,468 patients, with 1,775 in the WB group and 1,693 in the component therapy group.

Key Findings

While both groups exhibited similar overall incidence rates of VTE, logistic regression analysis revealed a notable 30% reduction in VTE risk associated with WB resuscitation compared to component therapy. This reduction underscores the potential of WB to enhance patient outcomes beyond merely improving survival rates, which has been the focus of previous studies on low titer group O whole blood (LTOWB).

Patient Characteristics and Resuscitation Strategies

The study also highlighted distinct differences between patients who received WB versus component therapy. WB recipients tended to be younger and had higher rates of penetrating injuries. They were also more frequently transported via helicopter and presented with higher Injury Severity Scores (ISS). Moreover, WB recipients were more likely to receive tranexamic acid (TXA) and VTE chemoprophylaxis within 48 hours of admission.

Caution with Tranexamic Acid (TXA)

Interestingly, the study identified an unexpected association between TXA exposure and a 2.5-fold increased risk of VTE among severely injured trauma patients receiving WB resuscitation. This finding challenges the conventional wisdom regarding TXA's role in mitigating bleeding complications and raises questions about its interaction with WB in trauma settings.

Implications for Clinical Practice

Commenting on the study's implications, Dr. Andrew D. Fisher, MD, a general surgery resident at the University of New Mexico School of Medicine, emphasized the importance of integrating these findings into trauma resuscitation protocols. He stressed the need for further prospective trials to validate these results and optimize strategies for managing VTE risk in trauma patients.

Future Directions and Research Needs

Brittany Hout underscored several avenues for future research. These include elucidating the mechanisms behind WB's protective effect against VTE, identifying actionable factors that contribute to reduced VTE risk in WB recipients compared to those receiving component therapy alone, and exploring optimal TXA dosing and timing in conjunction with WB resuscitation.

Conclusion

The study presented at the 2024 Annual Scientific Assembly provides compelling evidence supporting WB resuscitation as a promising strategy for reducing VTE risk in trauma patients. As an acute care surgeon dedicated to optimizing patient outcomes, these findings prompt a critical reassessment of current trauma resuscitation practices. Integrating WB into standard protocols could potentially enhance patient care and outcomes in emergency settings.

Hot Take Point: As an acute care surgeon, interested in the outcomes of my patients, this study underscores the critical role of WB resuscitation in reducing VTE risk, prompting a reassessment of current trauma protocols for improved patient care and safety.