Tranexamic acid at the point of injury: the Israeli combined civilian and military experience

Roy Nadler, Sami Gendler, Avi Benov, Refael Strugo, Amir Abramovich, Elon Glassberg
Journal of Trauma and Acute Care Surgery 2014, 77 (3 Suppl 2): S146-50

BACKGROUND: Accumulating evidence established the benefit of tranexamic acid (TXA) for traumatic bleeding in the hospital setting. TXA use in the field (at or near the point of injury [POI]) was described in the military setting but not in the civilian one. The current study describes the Israeli combined experience (civilian and military) of administering TXA in the field.

METHODS: The Israel Defense Forces (IDF) and Magen David Adom (MDA) (the national Israeli civilian emergency medical service) protocols for giving TXA at the POI are presented. We then review all trauma patients who received TXA in the field in accord with either protocol. Data were abstracted from the IDF Trauma Registry and from the MDA database.

RESULTS: Data regarding casualties treated with TXA by the IDF Medical Corps and MDA between December 2011 and August 2013 are presented. One hundred three casualties who received TXA in the field were identified. The median age was 26.5 years, and 83 (88%) were male. The mechanism of injury was penetrating in 48 cases (51%). POI data indicate slightly higher injury severity for the group of patients treated by MDA compared with patients treated by the IDF (systolic blood pressure, 90 mm Hg vs. 110 mm Hg; Glasgow Coma Scale [GCS] score, 11 vs. 15; hemoglobin, 11.9 vs. 13.3; p < 0.05).

CONCLUSION: On the basis of our combined data, it appears that administering TXA in the field is feasible in the civilian and the military setting. Lessons learned in military settings are applicable to civilian medical systems. Action investigations and comparison of the different protocols may further improve treatment at or near the POI.

LEVEL OF EVIDENCE: Therapeutic study, level V.

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