Effect of tranexamic acid on children with traumatic bleeding: A systematic review and meta-analysis

Area of Science:

• Pediatric Emergency Medicine
• Trauma Surgery
• Pharmacology

Background:

• Traumatic bleeding in children poses significant mortality risks.
• Evaluating antifibrinolytic agents like tranexamic acid (TXA) is crucial for improving outcomes.

Purpose of the Study:

• To systematically review and meta-analyze the efficacy and safety of TXA for pediatric traumatic bleeding.
• To assess TXA's impact on mortality, morbidity, and adverse events in pediatric trauma.

Main Methods:

• Comprehensive literature search of major databases for relevant cohort and randomized controlled trials.
• Inclusion criteria excluded studies on other anti-bleeding agents or patients with pre-existing bleeding disorders.
• Statistical analysis utilized random-effects models to calculate odds ratios for key outcomes.

Main Results:

• Ten studies (34,144 children) were analyzed, including one RCT and nine retrospective cohorts.
• TXA significantly reduced mortality (OR 0.58), particularly with a 1g initial dose.
• No significant differences were observed in ICU admission, surgical intervention, or hospital stay; a slight increase in seizures was noted, but no increase in thromboembolic events.

Conclusions:

• TXA demonstrates potential benefits in reducing mortality for pediatric trauma patients.
• The overall safety profile of TXA in this population appears favorable.
• Further research is warranted to establish optimal dosing and timing for TXA administration in pediatric trauma.