Intramuscular Tranexamic Acid in Tactical and Combat Settings

Area of Science:

• Emergency Medicine
• Trauma Surgery
• Pharmacology

Background:

• Uncontrolled hemorrhage is a primary cause of preventable death in combat and tactical scenarios.
• Investigating alternative delivery methods for tranexamic acid (TXA) is crucial for improving outcomes.
• The Committee for Tactical Emergency Casualty Care reviewed evidence for intramuscular (IM) TXA in prehospital settings.

Purpose of the Study:

• To evaluate the potential role and evidence supporting intramuscular (IM) administration of tranexamic acid (TXA).
• To assess the feasibility of early IM TXA administration in non-hospital settings following injury.

Main Methods:

• Systematic literature search of EMBASE and MEDLINE/PubMed for studies on prehospital TXA use.
• Keywords included: trauma, hemorrhagic shock, optimal timing, dose, volume, venous thromboembolism (VTE), and IM bioavailability.
• Review of 183 studies with variable data quality, including laboratory research, case reports, and observational studies.

Main Results:

• Current TXA formulations appear suitable for IM injection based on volume and concentration.
• Established guidelines support IM administration in multiple sites in adults.
• Limited data exists on IM TXA efficacy and safety specifically in hemorrhagic shock patients; one case series suggests complete bioavailability in healthy individuals.

Conclusions:

• Insufficient evidence currently exists to strongly recommend or refute IM TXA in combat settings.
• IM TXA is considered a viable option for tactical and combat applications, balancing risks and benefits.
• Further research is needed on optimal IM dosage, bioavailability in hemorrhagic shock, and potential adverse effects.