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The Use of Tranexamic Acid in Tactical Combat Casualty Care: TCCC Proposed Change 20-02

Brendon Drew, Jonathan D Auten, Andrew P Cap

    Journal of Special Operations Medicine : a Peer Reviewed Journal for SOF Medical Professionals
    |September 24, 2020
    PubMed

    Insights

    Tranexamic acid (TXA) is recommended for severely injured patients, including those with traumatic brain injury (TBI). The updated guidelines suggest a single 2g dose administered slowly via IV/IO push for optimal use.

    Area of Science:

    • Trauma care
    • Emergency medicine
    • Pharmacology

    Background:

    • Literature supports early tranexamic acid (TXA) use in severe trauma.
    • Uncertainty exists regarding optimal TXA administration, dosage, and timing.
    • TXA use has expanded beyond trauma, with new dosing strategies and data.

    Purpose of the Study:

    • Re-examine tranexamic acid (TXA) guidelines by the Committee on Tactical Combat Casualty Care (CoTCCC).
    • Address persistent questions on optimal medical and tactical use of TXA.
    • Incorporate new evidence and user community feedback into clinical recommendations.

    Main Methods:

    • Review of existing tranexamic acid (TXA) literature.
    • Analysis of data from trauma and non-trauma applications.
    • Consideration of user community feedback and tactical/logistical factors.

    Main Results:

    • Significant traumatic brain injury (TBI) is now an indication for TXA.
    • The recommended dosing protocol changed to a single 2g IV/IO administration.
    • Slow IV/IO push is the recommended administration method for TXA.

    Conclusions:

    • Updated TCCC guidelines reflect new evidence and address optimal TXA use.
    • TXA administration is refined for improved efficacy in severely injured patients.
    • The guidelines now include TBI as an indication, standardizing TXA protocols.

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