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performed only with gross inspection, whereas microscopic 8. Chang R, Cardenas JC, Wade CE, et al. Advances in the under-
and histopathologic methods could have picked up a lesser standing of trauma-induced coagulopathy. Blood. 2016;128(8):
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10. Morrison JJ, Ross JD, Dubose JJ, et al. Association of cryoprecip-
TXA administered via the IO and IM routes has the potential itate and tranexamic acid with improved survival following war-
to deliver antifibrinolytic therapy in the far forward setting on time injury: findings from the MATTERs II Study. JAMA Surg.
the battlefield, where the initial responder is potentially not 2013;148(3):218–225.
a trained medical provider capable of establishing IV access. 11. Shakur H, Roberts I, Bautista R, et al; CRASH-2 Collaborators.
Further investigation is required to determine efficacy and Effects of tranexamic acid on death, vascular occlusive events,
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dosing appropriate for an IM autoinjector, which would facil- orrhage (CRASH-2). Lancet. 2010;376:23–32.
itate rapid drug delivery when IV or IO access is unobtainable 12. Memo–Recommendations Regarding the Addition of Tranexamic
or impractical. Acid to the Tactical Combat Casualty Care Guidelines 2011-06. Avail-
able at: https://www.naemt.org/docs/default-source/education
Disclaimers/Disclosures -documents/tccc/tccc-updates_092017/tccc-reference-materials
The animals involved in this study were procured, maintained, /05-tccc-change-documents/11-2-dhb-memo-110923-txa.pdf?s
fvrsn=1085cd92_2. Accessed October 30, 2019.
and used in accordance with the Laboratory Animal Welfare 13. Vu EN, Wan WCY, Yeung TC, et al. Intramuscular tranexamic
Act of 1966, as amended, and NIH 80-23, Guide for the Care acid in tactical and combat settings. J. Spec Oper Med. 2018;18
and Use of Laboratory Animals, National Research Council. (1):62–68.
14. Lallemand MS, Moe DM, McClellan JM, et al. No intravenous
The views expressed in this material are those of the authors access, no problem: Intraosseous administration of tranexamic
and do not reflect the official policy or position of the US Gov- acid is as effective as intravenous in a porcine hemorrhage model.
J Trauma Acute Care Surg. 2018;84(2):379–385.
ernment, the Department of Defense, the Department of the Air 15. Andersson L, Nilsoon IM, Colleen S, et al. Role of urokinase and
Force, or the University of California, Davis. The work reported tissue activator in sustaining bleeding and the management thereof
herein was performed under United States Air Force Surgeon with EACA and AMCA. Ann N Y Acad Sci. 1968;146:642–58.
General approved Clinical Investigation No. FDG20160013A. 16. Nilsson I. Clinical pharmacology of aminocaproic and tranexamic
acids. J Clin Pathol. 1980;33(14):41–47.
No conflicts of interest were declared by any of the authors. 17. Yee BE, Wissler RN, Zanghi CN, et al. The effective concentra-
tion of tranexamic acid for inhibition of fibrinolysis in neonatal
plasma in vitro. Anesth Analg. 2013;117:767–772.
Funding 18. Fletcher D, Blackstock K, Epstein K, et al. Evaluation of tran-
The Clinical Investigation Facility, David Grant USAF Medical examic acid and ε-aminocaproic acid concentrations required to
Center, Travis Air Force Base, California provided funding for inhibit fibrinolysis in plasma of dogs and humans. Am J Vet Res.
this study. 2014;75(8):731–738.
19. Moore HB, Moore EE, Gonzalez E, et al. Hyperfibrinolysis,
physiologic fibrinolysis, and fibrinolysis shutdown: the spectrum
Author Contributions of postinjury fibrinolysis and relevance to antifibrinolytic ther-
AJD, SEF, JKG, and JMD conceived the study concept. ESD apy. J Trauma Acute Care Surg. 2014;77:811–817.
obtained funding. ESD, AJD, GLH, MAS, EMT, and JKG con- 20. Sigaut S, Tremey B, Ouattara A, et al. Comparison of two doses
ducted the experiment and collected data. ESD and JKG con- of tranexamic acid in adults undergoing cardiac surgery with car-
ducted data analysis. ESD wrote the first draft and all authors diopulmonary bypass. Anesthesiology. 2014;120(3):590–600.
read and approved the final manuscript. 21. Dai L, Bevan D, Rangarajan S, et al. Stabilization of fibrin clots by
activated prothrombin complex concentrate and tranexamic acid
in FVIII inhibitor plasma. Haemophilia. 2011;17(5):e944–e948.
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