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Tranexamic Acid in Pediatric Care: A Comprehensive Overview
Mohammed Alsabri1, Mayar M Aziz2, Karim Fahmy3
1Department Of Emergency Medicine, Al-Thawra Modern General Hospital, Sanaa, Yemen and Pediatric Emergency Department, St. Christopher's Hospital for Children, Philadelphia, PA (MA) USA.
Insights
Tranexamic acid (TXA) is effective for pediatric bleeding but needs more research on dosing, safety, and guidelines. Further studies and standardized protocols are crucial for its optimal use in children.
Area of Science:
- Pediatric Emergency Medicine
- Hematology
- Pharmacology
Background:
- Tranexamic acid (TXA) is a hemostatic agent with proven benefits in adult trauma and surgery.
- Its application in pediatric medicine for hemorrhage management is less researched, with existing knowledge gaps.
- Inconsistent pediatric-specific clinical guidelines highlight the need for further investigation.
Purpose of the Study:
- To review the efficacy, pharmacokinetics, dosing, and safety of TXA in pediatric populations.
- To identify knowledge gaps and inconsistencies in the current use of TXA for children.
- To inform the development of standardized pediatric protocols for TXA administration.
Main Methods:
- A targeted literature search was performed using PubMed and Google Scholar.
- Keywords included MeSH terms related to TXA efficacy, pharmacokinetics, dosing, and safety in children (0-18 years).
- Studies published between 1995 and February 2025 were included.
Main Results:
- TXA demonstrates efficacy in reducing blood loss, transfusion needs, and improving survival in pediatric trauma, surgery, and emergencies.
- Nebulized TXA shows potential for specific conditions like post-tonsillectomy hemorrhage.
- Significant gaps remain regarding age-specific pharmacokinetics, long-term safety, thromboembolic risks, and seizure risks.
Conclusions:
- TXA is critical for pediatric hemorrhagic emergencies, improving survival and outcomes.
- Further interdisciplinary research, standardized pediatric guidelines, and enhanced provider training are essential.
- Addressing knowledge gaps is key to safe and effective TXA implementation in diverse pediatric settings.
Objective:
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.
Methods:
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.
Results:
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.
Conclusion:
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.
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