Use of Whole Blood in Trauma Patients on Anticoagulation or Antiplatelet Therapy

Anticoagulation and antiplatelet (AC/AP) medications complicate hemorrhage control and are associated with increased mortality in trauma. Whole blood (WB) may be associated with different outcomes for hemorrhaging patients over component therapy (CT). We hypothesize that in hemorrhaging patients on AC/AP, WB is associated with improved outcomes over CT transfusion.

We retrospectively reviewed the National Trauma Data Bank (2020-2022) for AC/AP patients who received CT or WB+CT, excluding those who died within 1 h, were pregnant, were <18 y old, transferred from facilities, or with a head abbreviated injury score > 2. Univariable and multivariable analyses assessed mortality and secondary outcomes.

A total of 5580 patients met inclusion. A total of 4802 received CT and 778 WB+CT. WB+CT patients presented with lower systolic blood pressure, higher heart rate, greater injury severity, and were more likely to undergo emergent operation. They received a higher total blood product volume (1000 versus 600 mL, P < 0.01). WB+CT patients received a lower packed red blood cell volume (0 versus 350 mL, P < 0.01). WB+CT patients had longer hospital (10 versus 8 d, P < 0.01) and intensive care unit (ICU) stays (5 versus 4 d, P < 0.01).

WB+CT patients presented with more severe injuries and hemodynamic instability. Although hospital and ICU length of stay were longer in the WB+CT group on univariable analysis, after risk adjustment, there were no significant differences in mortality, hospital or ICU length of stay, or ventilator days between groups. Further research is warranted to evaluate the role of WB resuscitation in patients on AC/AP.