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Effectiveness and safety of tranexamic acid in pediatric trauma: A systematic review and meta-analysis
Emily Kornelsen1, Nathan Kuppermann2, Daniel K Nishijima3
1University of Toronto, Toronto, ON, Canada.
Insights
Tranexamic acid (TXA) did not improve survival in pediatric trauma patients overall. However, TXA showed increased survival in children with combat-related trauma, with no increased risk of blood clots.
Area of Science:
- Pediatric Trauma Care
- Emergency Medicine
- Pharmacology
Background:
- Trauma is the leading cause of death in children in the US.
- Tranexamic acid (TXA) is used to reduce bleeding but its effectiveness in pediatric trauma is not well-established.
- There is a need to evaluate TXA's impact on survival and safety in children with acute trauma.
Purpose of the Study:
- To determine the effectiveness of tranexamic acid (TXA) in improving survival in pediatric trauma patients.
- To assess the safety of TXA use in this population, specifically looking at thromboembolic events.
- To review existing literature on TXA in pediatric trauma to inform clinical guidelines.
Main Methods:
- A systematic review and meta-analysis of published studies was conducted.
- Searched multiple databases (MEDLINE, Embase, CINAHL, Web of Science) and grey literature for relevant studies up to February 2021.
- Included six single-institution and eight multicentre retrospective cohort studies, analyzing survival and safety outcomes.
Main Results:
- TXA use was not associated with increased survival in pediatric trauma overall (aOR: 0.61, 95% CI: 0.30-1.22).
- A significant increase in survival was observed in children with combat-related trauma (aOR for mortality: 0.31, 95% CI: 0.14-0.68).
- No significant difference in the odds of thromboembolic events was found between TXA recipients and non-recipients (OR 1.15, 95% CI: 0.46-2.87).
Conclusions:
- The overall utility of tranexamic acid (TXA) in pediatric trauma remains unclear.
- Current guidelines for TXA use in pediatric trauma may not be fully supported by existing evidence.
- Further rigorous clinical trials are needed to establish TXA's efficacy, optimal dosing, and meaningful outcomes in pediatric trauma.
Objective:
Trauma is the leading cause of childhood death in the United States. Our goal was to determine the effectiveness of tranexamic acid (TXA) in improving survival in pediatric trauma.
Methods:
MEDLINE (OVID), Embase (OVID), Cochrane Central Register databases, CINAHL (EBSCO), Web of Science (Clarivate Analytics), and grey literature sources were searched for publications reporting survival and safety outcomes in children receiving TXA in acute trauma, with no language restrictions, published until February 11, 2021. Two independent researchers assessed studies for eligibility, bias, and quality. Data on the study setting, injury type, participants, design, interventions, TXA dosing and outcomes were extracted. The primary outcome was survival in children who received TXA following trauma. Forest plots of effect estimates were constructed for each study. Heterogeneity was assessed and data were pooled by meta-analysis using a random-effects model.
Results:
Fourteen articles met inclusion criteria - six single-institution and eight multicentre retrospective cohort studies. Overall, TXA use was not associated with increased survival in pediatric trauma (adjusted odds ratio [aOR]: 0.61, 95% CI: 0.30-1.22) after adjustment for patient-level variables, such as injury severity. Increased survival was documented in the subset of children experiencing trauma in combat settings (aOR for mortality: 0.31, 95% CI: 0.14-0.68). There were no differences in the odds of thromboembolic events (OR 1.15, 95% CI: 0.46-2.87) in children who received TXA versus not.
Conclusions:
The utility of TXA in children with trauma is unclear. Guidelines supporting TXA use in pediatric trauma may not be based on the available evidence of its use in this context. Rigorous trials measuring survival and other meaningful outcomes and exploring optimal TXA dosing are urgently needed. Study Registration (PROSPERO): CRD42020157683.
