Introduction Acute trauma is the sudden application of force that causes damage to a living body,1 being one of the leading causes of mortality in the UK paediatric population.2,3 Bleeding is a leading cause death in paediatric trauma.4–6 Recent recognition that coagulation defects are associated with increased transfusion and mortality, has been termed acute coagulopathy of trauma (ACOT),7–9 (Figure 1). Attention has been given to the use of Tranexamic Acid (TXA) to prevent bleeding resulting from it. Tranexamic acid is a synthetic analogue of the amino acid lysine.10 The use of lysine analogues has been explored in various surgical studies in adults and children.11–15 The focus of this literature review is to search the current literature to elucidate the role of TXA in paediatric trauma.
Methods This is a scoping review. An electronic search was performed (Figure 2). The following combination of search terms was used: [tranexamic acid] AND [child*] OR [p?edia*] AND [trauma]. Only 2 studies were included.
Findings The PED-TRAX study was a retrospective review of paediatric trauma, TXA was administered within 3 hours of injury and re-dosed based on injury in all patients. TXA administration was associated with reduced mortality (Figure 3).16 Another retrospective study tested TXA in traumatic hyphema as secondary prevention for bleeding. The authors concluded that those treated with TXA were not less likely to re-bleed.17 Both studies had limitations (Figure 3). TXA has been found to reduce mortality in adult trauma in the CRASH-2 study.18 Even though the study had limitations (Figure 3), an evidence statement from the RCPCH recommends dosing translated to children from the CRASH-2.19
Conclusion Evidence suggests TXA in adult patients with severe trauma confers them survival advantages. There is little data about TXA in paediatric trauma population. There is a need for more research to understand the haemostatic differences throughout childhood, so that further understanding of ACOT in children is possible. RCT’s that evaluate effectiveness, safety and dosing of TXA in the paediatric trauma population in the UK and other parts of the world are needed.
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The Royal College of Paediatrics and Child Health, RCPCH. Children's medicines: Major trauma and the use of tranexamic acid in children. [Online] Available from: http://www.rcpch.ac.uk/system/files/protected/page/Major%20Trauma%20and%20the%20Use%20of%20Tranexamic%20Acid%20in%20Children%20-%20Evidence%20Statement%202012-11.pdf [Accessed 11th April 2015]
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