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Cost of the Defence Medical Services Patient Group Directive for a 10-minute tranexamic acid (TXA) infusion in trauma: a bolus is safe and saves lives
  1. Jake Gluyas-Harris1 and
  2. D McConnell1,2
  1. 1Emergency Department, Derriford Hospital, Plymouth, UK
  2. 2Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
  1. Correspondence to Dr Jake Gluyas-Harris, Emergency Department, Derriford Hospital, Plymouth PL6 8DH, UK; jacob.gluyas{at}


Tranexamic acid (TXA) is a life-saving drug that reduces the risk of death from haemorrhage. Intervention is time critical with benefit decreasing with delayed administration. The current Joint Service Publication Patient Group Directive (PGD) for giving TXA during the tactical field care phase of the operational patient care pathway specifies it is given over 10 min via intravenous infusion based on TXA’s Summary of Product Characteristics. This paper aims to explore the risks of administering TXA as a bolus rather than a 10-minute infusion. There is little evidence to support the risk of quoted adverse events from bolus administration of TXA, good-quality evidence for the mortality benefit of early administration and some evidence that bolus dosing is safe. The Defence Medical Service should consider a default PGD of rapid TXA administration to maximise mortality benefit.

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  • Contributors JG-H is the first author, contributing to planning, literature search, literature analysis and writing the manuscript. DM is the second author, contributing to planning, literature search, literature analysis and editing the manuscript. Both authors are responsible for overall content as guarantors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.