Packed red blood cell transfusion: a catalyst for thrombosis in patients with traumatic brain injury?

INTRODUCTION

This study investigated the relationship between trauma patients with TBI who did and did not receive blood product transfusions and the incidence of venous thromboembolism (VTE) hypothesizing transfusions increase VTE risk.

METHODS

The Trauma Quality Improvement Program (TQIP) was queried from 2017 to 2021 to identify adult (≥18 years-old) patients with TBI. Patients with TBI receiving any blood product transfusions within 4 h of arrival were compared to those who did not. Outcomes were compared using bivariate analyses and a multivariable logistic regression to identify predictors of VTE.

RESULTS

Of 451,061 patients with TBI, 32,276 (7.2%) patients received a blood transfusion. Thrombotic events were more frequently observed in transfused patients such as VTE (7.6% vs 1.4%, p < 0.001), comprised of deep vein thrombosis (6.0% vs 1.1%, p < 0.001) and pulmonary embolism (2.3% vs 0.4%, p < 0.001). Blood product transfusion was associated with an increased risk of VTE (OR 1.34, CI 1.11-1.62, p = 0.003). However, when individually analyzed, only pRBC transfusion was independently associated with increased VTE risk (OR 1.37, CI 1.24-1.51, p < 0.001).

CONCLUSIONS

Trauma patients with TBI undergoing early blood product transfusion had a nearly 50% increased risk of VTE, compared to patients not undergoing transfusion. This risk was primarily attributed to the use of pRBC.

LEVEL OF EVIDENCE: IV (therapeutic).