Tranexamic acid in pediatric hemorrhagic trauma

There is strong evidence in adult literature that tranexamic acid (TXA) given within 3 hours from injury is associated with improvedoutcomes. 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 studiesindicate 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 studieshave identified three distinct fibrinolytic phenotypes following trauma (hyperfibrinolysis, physiologic fibrinolysis, and fibrinolyticshutdown), which can be identified with viscohemostatic assays. Whether viscohemostatic assays can appropriately identify childrenwho may benefit or be harmed by TXA is also unknown. Copyright (C) 2022 Wolters KluwerHealth, Inc. All rights reserved.