Tranexamic acid in pediatric hemorrhagic trauma

J Trauma Acute Care Surg. 2023 Jan 1;94(1S Suppl 1):S36-S40. doi: 10.1097/TA.0000000000003775. Epub 2022 Aug 31.

Abstract

There is strong evidence in adult literature that tranexamic acid (TXA) given within 3 hours from injury is associated with improved outcomes. The evidence for TXA use in injured children is limited to retrospective studies and one prospective observational trial. Two studies in combat settings and one prospective civilian US study have found association with improved mortality. These studies indicate the need for a randomized controlled trial to evaluate the efficacy of TXA in injured children and to clarify appropriate timing, dose and patient selection. Additional research is also necessary to evaluate trauma-induced coagulopathy in children. Recent studies have identified three distinct fibrinolytic phenotypes following trauma (hyperfibrinolysis, physiologic fibrinolysis, and fibrinolytic shutdown), which can be identified with viscohemostatic assays. Whether viscohemostatic assays can appropriately identify children who may benefit or be harmed by TXA is also unknown.

Publication types

  • Randomized Controlled Trial
  • Observational Study

MeSH terms

  • Antifibrinolytic Agents* / pharmacology
  • Antifibrinolytic Agents* / therapeutic use
  • Blood Coagulation Disorders* / drug therapy
  • Blood Coagulation Disorders* / etiology
  • Hemorrhage / drug therapy
  • Hemorrhage / etiology
  • Humans
  • Prospective Studies
  • Retrospective Studies
  • Tranexamic Acid* / pharmacology
  • Tranexamic Acid* / therapeutic use
  • Wounds and Injuries* / complications
  • Wounds and Injuries* / drug therapy

Substances

  • Tranexamic Acid
  • Antifibrinolytic Agents