The Role of Tranexamic Acid in Future Combat Casualty Care

Download the full article here: No. 25-1039, The Role of Tranexamic Acid in Future Combat Casualty Care (Jul 25) [PDF - 2.2 MB]

EXECUTIVE SUMMARY

This paper is geared toward the Department of Defense medical community, in particular, the U.S. Army Medical Command (USAMEDCOM), and advocates for the widespread adoption of tranexamic acid (TXA) across all levels of military medical care to significantly reduce trauma-related mortality. Evidence from civilian trials (Clinical Randomization of an Antifibrinolytic in Significant Haemorrhage-2 [CRASH-2]), military studies (Military Application of Tranexamic Acid in Trauma Emergency Resuscitation [MATTERS]), the recent experience in the Russia-Ukraine War, and the subsequent Clinical Randomization of Tranexamic Acid to Improve Survival in Trauma (CRITICAL) study demonstrates TXA’s effectiveness in controlling hemorrhage and improving survival rates. Ukraine reports a 33-percent reduction in deaths.

TXA is a cost-effective intervention (at approximately $30 per dose), particularly crucial in scenarios with prolonged prehospital care, such as anticipated future large-scale combat operations (LSCO). The paper recommends USAMEDCOM prioritize TXA implementation, including collaboration with international partners to develop and deploy a TXA auto-injector for rapid administration in the field. Expanding TXA access is a vital step toward enhancing battlefield survivability and improving patient outcomes, especially within the LSCO environment.