Prehospital Tranexamic Acid Administration in Deployed Military Settings: A Review of the Department of Defense Trauma Registry.
Medical journal (Fort Sam Houston, Tex.) · 2025-01-01 · Registry study
Abstract
Introduction: Trauma is the leading cause of death worldwide, with up to 40% of trauma fatalities resulting from massive hemorrhage. Tranexamic Acid (TXA) helps control massive bleeding by stabilizing clot formation and was added to the Tactical Combat Casualty Care (TCCC) guidelines in 2011. In 2020, the Committee on TCCC updated the dosing recommendation to a 2g IV slow push to simplify administration in combat settings. Despite this change, little is known about the characteristics of prehospital TXA administration in deployed combat settings, prompting the present investigation. Materials and Methods: This was a retrospective review of the Department of Defense Trauma Registry (DoDTR) dataset spanning 2007 to 2023. We identified casualties who received any dose of TXA (per-administration) as well as every patient who received TXA once or more (per-casualty). Results: From 2007 to 2023, there were 45,124 total DoDTR encounters within our dataset that met inclusion criteria, including 698 TXA administrations given to 671 casualties. The median time from injury to administration was 44 minutes (IQR 30-77 minutes). The median dose administered was 1000 mg (IQR 1000-1000, max 3000). 6% received a 2000 mg dose, and <1% received a 3000 mg dose. Intravenous administration was the most common route of delivery (64%), followed by intraosseous (11%), and intramuscular (<1%) delivery. A total of 46% of patients received TXA at the point-of-injury followed by administration en route to a higher level of care (38%) with the remainder having no location documented. Of those who received TXA at the point of injury and en route to the higher level of care, 55% and 29% went on to receive ≥3 and ≥10 units of whole blood or red blood cells, respectively. Conclusions: Frequent reliance on IO and IM use underscores the need for field-friendly solutions that allow for rapid, easy delivery via multiple routes. Future research should focus on evaluating intramuscular TXA and developing material solutions to streamline battlefield execution.
Tags
Haemostatics · Intraosseous access · Military & tactical · Tranexamic acid