Prehospital Tranexamic Acid for Traumatic Hemorrhage: A Clinical Review Integrating Civilian, Rural, Helicopter, Military, and Austere Trauma Systems

Authors

• Joel D. Gonzalez, University of LynchburgFollow

Specialty

Trauma, Surgery, Emergency Medicine, Critical Care, Military Medicine, Global Health, Public Health

Abstract

Traumatic hemorrhage remains the leading cause of preventable death worldwide, remaining one of the continuous challenges for the trauma systems across civilian, military, rural, and austere environments. The early administration of tranexamic acid (TXA), particularly within the first three hours following injury, has been shown to significantly reduce mortality by attenuating trauma-induced hyperfibrinolysis and stabilizing clot formation. Large clinical trials and practical experience have consistently demonstrated its safety, low cost, and survival benefit when administered immediately. Despite this robust evidence base, integration of TXA into prehospital trauma care remains inconsistent, restricting access during the critical early window in which antifibrinolytic therapy is most effective. Prehospital TXA administration remains associated with improved survival, particularly in settings characterized by prolonged transport times, delayed access to definitive surgical care, and resource limitations. Nonetheless, across-the-board implementation continues to face barriers, including variability in regional protocols and scope-of-practice regulations, limitations, and operational and logistical challenges, driven by concerns about medication storage and drug stability in field environments. Even in the context of such concerns, military medical frameworks have incorporated TXA as a foundational component of remote damage-control resuscitation and prolonged field care, demonstrating the feasibility and operational value of standardized early antifibrinolytic therapy; supported by its established mortality benefit, favorable safety profile, and minimal resource burden, TXA represents a high-impact opportunity for system-level improvement in trauma care delivery. Standardization of prehospital protocols, streamlined dosing strategies, extended provider education, and coordinated integration across trauma systems are essential steps toward reducing preventable hemorrhagic deaths and optimizing global trauma system performance.

Recommended Citation

Gonzalez JD. Prehospital Tranexamic Acid for Traumatic Hemorrhage: A Clinical Review Integrating Civilian, Rural, Helicopter, Military, and Austere Trauma Systems. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2026; 8(1).