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Mosa Safi: Updated TXA Recommendations in Tactical Combat Casualty Care
Mosa Safi/LinkedIn
May 21, 2026, 13:08

Mosa Safi: Updated TXA Recommendations in Tactical Combat Casualty Care

Mosa Safi, Senior Medical Instructor at Prometheus Medical International, shared a post on LinkedIn:

“Tranexamic Acid (TXA) is now given as a single 2 g slow IV/IO push, replacing the older protocol of 1 g over 10 min and 1 g infusion over 8 hrs.

Current TCCC indications

Give TXA ASAP (within 3 hours of injury) if casualty has:

  • Hemorrhagic shock / expected major transfusion
  • Major amputation
  • Penetrating torso trauma
  • Severe bleeding
  • Significant TBI or altered mental status after blunt/blast trauma.

Current TCCC Dose

TXA 2 g IV/IO slow push (single dose)

Why the change?

  • Simplifies care in austere/combat settings
  • Reduces missed second doses
  • Emerging evidence suggests potential benefit in severe TBI
  • Less cognitive load during prolonged evacuation

Important

Benefit decreases with delayed administration.

After more than 3 hours, TXA may lose benefit and potentially increase harm in bleeding trauma.

Teaching pearl

‘Early TXA matters more than perfect TXA dosing.’

Bottom line

  • TCCC moved from 1 g and 1 g infusion – single 2 g TXA dose
  • Include severe TBI among TXA indications
  • Administer as early as possible and within 3 hours of injury.”

Mosa Safi: Updated TXA Recommendations in Tactical Combat Casualty Care

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