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The 2g TXA dose described here demonstrated no adverse towards determining the efficacy of this more tactically feasi-
reactions in young healthy male warfighters, but whether 2g ble method of TXA administration compared to the present
is the optimal TXA dose is an open emul in determining the slow and cumbersome protocol.
optimal TXA dose to foster positive casualty outcomes.
Funding
It is important to continually assess TXA protocol compli- This work was supported by a collaboration between the 75th
ance. The 2019 TCCC TXA protocol is slow and cumber- Ranger Regiment and the Combat Trauma Research Group
some, leading to compliance shortfalls. While the simplified West.
14
2g TXA flush described here should improve protocol com-
pliance, actual compliance is empirically measurable, and Disclosure
an important focus toward optimizing casualty outcomes. The authors have no financial or other conflicts of interest to
As evident by the lack of documented post-TXA vitals in disclose.
case 6, it is equally important to develop methods to fos-
ter reliable battlefield recordings of vitals and completeness Author Contributions
of AARs. CA, WB, DLR, and RK conceived the process improvement
investigation concept. CA, WB, and DLR coordinated and
There were no incidences of known TXA adverse effects, in- collected data. CA, WB, DLR, GJZ, CM, TD, BD, and RK
cluding hypotension, seizures, or anaphylaxis, observed in analyzed data. CA, WB, and GJZ wrote the manuscript. SG
the present case series, but large-sample studies are needed. provided medic review of the data and provided subject matter
These studies should include subanalyses to account for co- expertise. All authors made significant edits to the manuscript.
morbidities, such as disseminated intravascular coagulation,
non steroidal anti-inflammatory drug (NSAID) use, and other References
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follow-up to assess the full efficacy and safety of TXA when [published correction appears in J Trauma Acute Care Surg.
2013;74(2):706. Kotwal, Russell S [corrected to Kotwal, Russ
administered via this novel method. S]]. J Trauma Acute Care Surg. 2012;73(6 suppl 5):S431–S437.
2. TCCC guidelines for medical personnel. 31 January 2017. https://
Finally, research is needed to determine optimal route for www.naemt.org/docs/default-source/education-documents/tccc
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dexterity. IO access can be obtained by feel alone, which is preventable death on the battlefield. Arch Surg. 2011;146(12):
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21
their speed of IO infusion, which is important because faster patients with significant haemorrhage (CRASH-2): a randomised,
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it may be prudent to train IO users with an instrumented IO 6. CRASH-3 trial collaborators. Effects of tranexamic acid on death,
push preparation so that they can directly observe the relation- disability, vascular occlusive events and other morbidities in pa-
ship between the rates of infusion and the pressures they are tients with acute traumatic brain injury (CRASH-3): a randomised,
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21
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(IM) route could dramatically increase both the simplicity 8. Forbes CD, Barr RD, Reid G, et al. Tranexamic acid in control of
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bidities in women with post-partum haemorrhage (WOMAN): an
identify the effectiveness and safety of IM-administered TXA international, randomised, double-blind, placebo-controlled trial.
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to Tactical Combat Casualty Care guidelines for the administra-
This case series provides a foundation for larger investigations tion of tranexamic acid. J Emerg Med. 2019;57(5):646–652.

90 | JSOM Volume 20, Edition 4 / Winter 2020