Tranexamic acid and perioperative bleeding in children: what do we still need to know?

Area of Science:

• Anesthesiology
• Pediatric Surgery
• Pharmacology

Background:

• Perioperative bleeding and blood transfusions increase pediatric morbidity and mortality.
• Effective bleeding management reduces risks and healthcare costs.
• Tranexamic acid (TXA) is an antifibrinolytic agent used across various surgical and medical settings.

Purpose of the Study:

• To review current pediatric indications and contraindications for tranexamic acid (TXA).
• To evaluate the efficacy and safety of TXA in pediatric populations based on existing research.
• To provide evidence-based recommendations for TXA use in children.

Main Methods:

• Literature review of published studies on TXA in pediatric patients.
• Analysis of clinical trial data and observational studies.
• Synthesis of evidence regarding TXA's impact on bleeding and transfusion rates.

Main Results:

• TXA administration is well-tolerated and effective in reducing bleeding and allogeneic blood product transfusions in pediatric patients.
• TXA improves outcomes for pediatric patients undergoing surgery, trauma, or obstetrics.
• Recent guidelines recommend TXA as a key component of pediatric blood management protocols.

Conclusions:

• The recommended pediatric dosing regimen for TXA in trauma and surgery is a 10–30 mg/kg loading dose followed by a 5–10 mg/kg/h maintenance infusion.
• Larger prospective trials are needed to confirm optimal TXA dosing for maximal efficacy and minimal side effects in high-risk pediatric groups.
• Future research should aim to establish ideal TXA plasma concentrations for pediatric patients.