Article Text

PDF
G222(P) The role of tranexamic acid in acute paediatric trauma
  1. P Couret-Alcaraz1,2,
  2. I Maconochie1,2
  1. 1Paediatrics and Child Health, Imperial College London, London, UK
  2. 2Paediatrics, Imperial College NHS Healthcare Trust, London, UK

Abstract

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.

References

  1. Centers for Disease Control and Prevention CDC. NIOSH Program portafolio: Traumatic injury. [Online] Available from: http://www.cdc.gov/niosh/programs/ti/ [Accessed 10th April 2015]

  2. Royal College of Paediatrics and Child Health. Child Mortality: why children die: deaths in infants children, and young people in the UK. [Online] Available from: http://www.rcpch.ac.uk/improving-child-health/child-mortality/child-mortality#infographics [Accessed 10th April 2015]

  3. World Health Organisation Regional Office for Europe. European Detailed Mortality Database. [Online] Available from: http://data.euro.who.int/dmdb/ [Accessed 10th April 2015]

  4. Kauvar DS, Lefering R, Wade CE. Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma 2006;60:S3–S11

  5. Eastridge BJ, Mabry RL, Seguin P, Cantrell J, Tops T, Uribe P, Mallett O, Zubko T, Oetjen-Gerdes L, Rasmussen T, et al. Death on the battlefield (2001–2011): implications for the future of combat casualty care. J Trauma Acute Care Surg 2012;73:S431–S437

  6. Hess JR, Brohi K, Dutton RP, et al. The coagulopathy of trauma: a review of mechanisms. J Trauma 2008;65:748–54

  7. Kutcher ME, Cripps MW, McCreery RC, Crane IM, Greenberg MD, Cachola LM, Redick BJ, Nelson MF, Cohen MJ. Criteria for empiric treatment of hyperfibrinolysis after trauma. J Trauma Acute Care Surg 2012;73:87–93

  8. Brohi K, Singh J, Heron M, Coats T. Acute traumatic coagulopathy. J Trauma 2003;54:1127–30

  9. Maegele M, Lefering R, Yucei N, Tjardes T, Rixen D, Paffrath T, SimanskiC, Neugebauer E, Bouillon B, et al. Early coagulopathy in multiple injury: an analysis from the German Trauma Registry on 8724 patients. Injury 2007;38:298–304

  10. Okamoto S, Hijikata-Okunomiya A, Wanaka K, Okada Y, Okamoto U: Enzyme controlling medicines: introduction. Semin Thromb Hemost 1997;23:493–501

  11. Zufferey P, Merquiol F, Laporte S, Decousus H, Mismetti P, Auboyer C, Samama CM, Molliex S. Do antifibrinolytics reduce allogeneic blood transfusion in orthopedic surgery? Anesthesiology 2006;105:1034–46

  12. Eaton MP. Antifibrinolytic therapy in surgery for congenital heart disease. Anesth Analg 2008;106:1087–100

  13. Faraoni D, Willems A, Melot C, De Hert S, Van der Linden P. Efficacy of tranexamic acid in paediatric cardiac surgery: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2012;42:781–6

  14. Tzortzopoulou A, Cepeda MS, Schumann R, Carr DB. Antifibrinolytc agents for reducing blood loss in scoliosis surgery in children. Cochrane Database Syst Rev 2008;3:CD006883

  15. Schouten ES, van de Pol AC, Schouten AN, Turner NM, Jansen NJ, Bollen CW. The effect of aprotinin, tranexamic acid, and aminocaproic acid on blood loss and use of blood products in major pediatric surgery: a meta-analysis. Pediatr Crit Care Med 2009;10:182–90

  16. Eckert MJ, Wertin TM, Tyner SD, Nelson DW, Izenberg S, Martin MJ. Tranexamic acid administration to pediatric trauma patients in a combat setting: the pediatric trauma and tranexamic acid study (PED-TRAX). The journal of trauma and acute care surgery 2014;77(6):852–8; discussion 858

  17. Albiani DA, Hodge WG, Pan YI, Urton TE, Clarke WN. Tranexamic acid in the treatment of pediatric traumatic hyphema. Canadian journal of ophthalmology. Journal canadien d'ophtalmologie 2008;43(4) 428–31

  18. CRASH-2 trial collaborators, Shakur H, Roberts I, Bautista R, Caballero J, Coats T, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 2010;376(9734) 23–32

  19. 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]

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.