Tranexamic Acid in Pediatric Care: A Comprehensive Overview

Tranexamic acid (TXA) is a vital hemostatic agent in pediatric medicine, demonstrating substantial efficacy in managing both traumatic and nontraumatic hemorrhage. Although TXA has been widely adopted in adult trauma and surgical care, reducing mortality, minimizing transfusion requirements, and controlling perioperative and emergency-related bleeding, its pediatric use remains under researched, with knowledge gaps in optimal dosing, long-term safety, and thromboembolic risks. Pediatric-specific clinical guidelines remain inconsistent, necessitating further research on their role in pediatric emergency and perioperative care.

A targeted literature search using a combination of MeSH terms and keywords was conducted using PubMed and Google Scholar, covering relevant studies focusing on the efficacy, pharmacokinetics, dosing strategies, and safety profile of TXA in children (ages 0-18 years) published between 1995 and February 2025.

Evidence supports the efficacy of TXA in reducing blood loss, minimizing transfusion needs, and improving survival outcomes in pediatric trauma, surgery, and emergency settings. Alternative administration routes, such as nebulized TXA, show promise for post-tonsillectomy hemorrhage and refractory epistaxis, potentially reducing the need for invasive interventions. However, gaps persist regarding age-specific pharmacokinetics, long-term safety, and potential thromboembolic and seizure risks. Inconsistent clinical practice, limited provider familiarity, and a lack of standardized pediatric protocols further hinder the use of TXA in pediatric settings.

TXA remains a critical intervention for improving survival and clinical outcomes in pediatric hemorrhagic emergencies. However, its full potential depends on further interdisciplinary research, the development of standardized pediatric-specific guidelines, and enhanced provider training. Addressing knowledge gaps will be essential to ensuring safe implementation of TXA across diverse pediatric clinical scenarios.