TXA in combat casualty care--does it adversely affect extremity reconstruction and flap thrombosis rates?

Tranexamic acid (TXA) is an antifibrinolytic that competitively inhibits the activation of plasminogen to plasmin. In recent years, the military has adapted TXA's use in combat casualties suffering severe hemorrhagic injuries. The purpose of this study is to examine the association between TXA on complications such as venous thromboembolic events (VTEs) and flap-related thrombosis in combat trauma patients undergoing tissue transfer for extremity reconstruction.

A retrospective chart review of war wounded undergoing extremity reconstructions from 2003 to 2012 at Walter Reed National Military Medical Center was completed. Data collected included patient demographics and administration of TXA. Outcomes measured included VTE rates and flap complications in TXA and non-TXA cohorts.

From 2003 to 2012, 173 extremity flap procedures were performed (100 pedicle, 73 free flaps). TXA was used in 11% of all patients reviewed. The overall VTE rate was 23.7%; however, there were no documented VTEs in patients who received TXA. Total flap complications, 26% versus 21%, or flap failure, 5% versus 4%, (p=0.571 and 0.564, respectively) did not differ significantly between those that received TXA versus those that did not.

Given the increasing use of TXA in the combat casualties, concern over its impact on VTE rates and flap complications is of interest. However, in this early review, we did not find significant differences in patients who received TXA and those that did not. Further research is indicated to better determine the significance and the effect of TXA on complex limb salvages.