Page 43 - JSOM Fall 2020

– Is TXA Effective When Administered IM to Bleeding Current Wording
Trauma Patients?
No, it is not supported in TCCC by the current evidence. Care Under Fire
– Is TXA Effective When Administered Via the IO Route to None.
Bleeding Trauma Patients? Tactical Field Care
Yes
– Can TXA Be Safely Given as a Slow (1-minute) IV Push c. Tranexamic Acid (TXA)
• If a casualty is anticipated to need significant blood
Rather Than over 10 minutes? transfusion (for example: presents with hemorrhagic
Yes shock, one or more major amputations, penetrating
– Can TXA Be Given in the Same IV/IO Line as Blood/ torso trauma, or evidence of severe bleeding):
Blood Products? – Administer 1g of tranexamic acid in 100mL normal
Yes saline or lactated Ringer’s as soon as possible but
– What Is “Initial Fluid Resuscitation?” as Mentioned in the NOT later than 3 hours after injury. When given, TXA
TCCC Guidelines with Respect to TXA? And when does should be administered over 10 minutes by IV infusion.
it end? – Begin the second infusion of 1g TXA after initial
TXA should be administered as early as possible after fluid resuscitation has been completed.
the injury, taking the tactical situation and prioritization
of interventions (MARCH) into account. The phrase “af- TACEVAC
ter initial fluid resuscitation has been completed” has been c. Tranexamic Acid (TXA)
removed from the updated TCCC Guidelines. The updated • If a casualty is anticipated to need significant blood
administration recommendations and dosing protocol transfusion (for example: presents with hemorrhagic
eliminate the need for this decision point. shock, one or more major amputations, penetrating
– Should the Dose of TXA be Modified in the Presence of torso trauma, or evidence of severe bleeding):
Ongoing Hemorrhage? – Administer 1g of tranexamic acid in 100mL normal
Based on the limited available evidence at present and saline or lactated Ringer’s as soon as possible but
the personal experience of the authors, an evidence-based NOT later than 3 hours after injury. When given, TXA
recommendation for redosing of TXA in the prehospital should be administered over 10 minutes by IV infusion.
phase of care (TCCC) cannot be made at this time. In- – Begin the second infusion of 1g TXA after initial
hospital administration of TXA should be guided by the fluid resuscitation has been completed.
casualty’s fibrinolytic status as measured clinically.
– Can TXA Be Administered through the Same Line as
Hextend? PROPOSED CHANGE
Yes. Although the preferred resuscitation fluid in TCCC
is whole blood, Hextend is still—at the time of this writ-
ing—a TCCC-recommended resuscitation fluid if no blood Care Under Fire
products are available. A recent study of this issue found no None.
evidence that Hextend and TXA are incompatible.
– If removed from glass vials in preparation for administra- Tactical Field Care
tion, how long can TXA be kept in a syringe? c. Tranexamic Acid (TXA)
Although TXA is very stable throughout a range of • If a casualty will likely need a blood transfusion (for
temperatures for several days, 163,164 there are no studies example: presents with hemorrhagic shock, elevated lac-
to support storage outside of the original packaging (for tate, one or more major amputations, penetrating torso
example, in a pre-drawn syringe). Under routine condi- trauma, or evidence of severe bleeding)
tions, medications are given within a few hours of being OR
prepared. Operational units should evaluate the need to • If the casualty has signs or symptoms of significant TBI
draw and store TXA prior to missions or operations and or has altered metal status associated with blast injury
adjust practice based on the tactical and/or logistical situ- or blunt trauma:
ation. Providers should consult their medical director for – Administer 2g of tranexamic acid via slow IV or IO
guidance regarding drawing and storing medications prior push as soon as possible but NOT later than 3 hours
to administration. after injury.

Given the volume of active TXA research, the authors TACEVAC
recommend that the CoTCCC consider another review c. Tranexamic Acid (TXA)
of updated TXA literature within 2 years of this change. • If a casualty will likely need a blood transfusion (for
example: presents with hemorrhagic shock, elevated lac-
tate, one or more major amputations, penetrating torso
trauma, or evidence of severe bleeding)
OR
• If the casualty has signs or symptoms of significant TBI
or has altered metal status associated with blast injury
or blunt trauma:

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