Isolated extremity hemorrhage control has significantly improved with the routine use of tourniquets, and junctional hemorrhage is more effectively addressed with CoTCCC-recommended hemostatic dressings or junctional tourniquets. As a result, noncompressible hemorrhage is now the cause of up to 67% of hemorrhagic deaths on the battlefield.

Tranexamic acid (TXA) has been widely used for decades to prevent blood loss in surgical settings by inhibiting the breakdown in clots that naturally occur in the fibrinolytic process. And since its inclusion in the TCCC guidelines in 2011, additional studies in both military and civilian prehospital care settings have confirmed that it is beneficial in trauma casualties, as well.

Its mechanism of action allows for maintenance of clots that have been formed in areas where external controls measures (tourniquets, hemostatic dressings, etc.) are ineffective, though it is also indicated in severe bleeding from injuries that are likely to be managed with massive hemorrhage control measures you have already learned. In addition to its beneficial effects in cases of severe bleeding, other studies have demonstrated improvement in both mortality and morbidity from head trauma and traumatic brain injury (TBI), and that has recently been added to the list of indications for TXA administration.

The dosage, route(s), and indications for administering TXA include:

### DOSAGE(S)

2 gm slow IV or IO push, as soon as possible (NOT later than 3 hours after injury)

### ROUTE(S)

Tranexamic Acid is available IV or IO form

### INDICATIONS for Administering TXA

- Hemorrhagic shock
- Elevated lactate
- One or more major amputations
- Penetrating torso trauma
- Evidence of severe bleeding

### OR

- A casualty with signs or symptoms of significant TBI
- Altered mental status associated with blast injury or blunt trauma.