DOES WHOLE BLOOD RESUSCITATION INCREASE RISK FOR VENOUS THROMBOEMBOLISM IN TRAUMA PATIENTS? A COMPARISON OF WHOLE BLOOD VS COMPONENT THERAPY IN 3468 PATIENTS.

Background: Whole blood (WB) resuscitation has been shown to provide mortality benefit. However, the impact of whole blood transfusions on the risk of venous thromboembolism (VTE) remains unclear. We sought to compare the VTE risk in patients resuscitated with WB vs component therapy (COMP).

Methods: Trauma patients aged 18 and older, admitted to two Level 1 trauma centers between 2016 and 2021, who received at least one unit of emergency-release blood products were identified. Clinical and transfusion data were collected. Patients that received any WB during resuscitation were compared to those who received only COMP therapy. The primary outcome was VTE incidence, defined as deep vein thrombosis and/or pulmonary embolism.

Results: 3468 patients met inclusion criteria (WB: 1775, COMP: 1693). WB patients were more likely to be male (82 vs. 68%), receive tranexamic acid (21 vs. 16%), and had higher Injury Severity Score (ISS, 26 vs. 19; all p < 0.001). WB patients exhibited less hospital-free days (11 vs. 15), ICU-free days (23 vs. 25), and 30-day survival (74 vs. 84; all p < 0.001). The WB group had lower VTE incidence (6 vs. 10%; p < 0.001). Logistic regression revealed WB was protective against VTE (OR 0.70, 95% CI 0.54-091, p = 0.009), while RBC transfusions and TXA exposure increased VTE risk.

Discussion: Using WB as part of resuscitation was associated with a 30% reduction in VTE, while TXA and RBC transfusion increased VTE risk. Further research is needed to evaluate VTE risk with empiric use of TXA in the setting of early WB transfusion capability.