Efficacy and Safety of Tranexamic Acid in Pediatric Trauma: A Systematic Review and Meta-Analysis

Abstract

OBJECTIVE Tranexamic acid (TXA) is a widely used antifibrinolytic agent in surgical and trauma settings in adults. This study aimed to evaluate the efficacy and safety of TXA in pediatric trauma patients across ­various clinical outcomes. METHODS A comprehensive literature search was conducted across 4 databases. We included clinical trials and observational studies that reported the use of TXA in pediatric trauma patients (aged ≤18 years). Data extraction and risk-of-bias assessment were performed by independent reviewers. Meta-analyses were conducted with RStudio software. RESULTS A total of 12 studies (2 randomized controlled trials [RCTs] and 10 observational) involving 66,398 pediatric trauma patients were included. Tranexamic acid was not significantly associated with reduction in hospital mortality (OR = 1.06; 95% CI, 0.32–3.45) but was associated with significantly shorter hospital stays (mean difference [MD] = −1.49; 95% CI, −2.43 to −0.56). The need for emergency mechanical ventilation was higher among the TXA group (OR = 4.29; 95% CI, 2.52–7.31), whereas the need for mechanical ventilation at discharge was lower (OR = 0.23; 95% CI, 0.08–0.64). Tranexamic acid use did not significantly alter the risk of thromboembolic events (OR = 0.72; 95% CI, 0.19–2.79) or poor neurological outcomes (OR = 2.51; 95% CI, 0.86–7.35). CONCLUSION Tranexamic acid may reduce hospital length of stay in pediatric trauma patients, with inconsistent effects on mortality and adverse events. Its use should be individualized based on injury severity and resource availability. Further high-quality research is needed to confirm these findings and clarify the role of TXA in pediatric trauma care.