What is the dose of Tranexamic acid (TXA) in pediatric patients?

From the Guidelines

Tranexamic acid should be dosed at 10 to 15 mg/kg followed by an infusion of 1 to 5 mg/kg per hour in pediatric patients. This dosing regimen is based on the updated European guideline for the management of bleeding following major trauma, which suggests that antifibrinolytic agents be considered in the bleeding trauma patient 1. The guideline recommends monitoring of fibrinolysis in all patients and administration of antifibrinolytic agents in patients with established hyperfibrinolysis.

Some key points to consider when administering tranexamic acid to pediatric patients include:

• The medication works by inhibiting fibrinolysis, which helps maintain clot stability and reduces bleeding 1.
• The plasma half-life of tranexamic acid is 120 minutes, and it is distributed throughout all tissues 1.
• In vitro studies have suggested that a dose of 10 μg/ml is required to inhibit fibrinolysis 1.
• The risk of precipitated thrombosis with the use of tranexamic acid remains a concern, and patients should be monitored for signs of thrombosis, especially those with risk factors 1.

It is essential to note that the efficacy of tranexamic acid in trauma has been assessed by the Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage (CRASH) II study, although the results of this trial are not directly applicable to pediatric patients 1. However, the suggested dosages in the guideline can be used as a reference for pediatric patients.

The dosing regimen of tranexamic acid may need to be adjusted for patients with renal impairment, and the medication should be administered slowly when given intravenously to avoid hypotension 1. Overall, tranexamic acid can be an effective medication for reducing bleeding in pediatric patients, but its use should be guided by thrombelastometric monitoring if possible and stopped once bleeding has been adequately controlled 1.

From the FDA Drug Label

1. 1 Recommended Dosage The recommended dose of Tranexamic acid is 10 mg/kg actual body weight intravenously administered as a single dose, immediately before tooth extractions. Following tooth extraction, Tranexamic acid may be administered for 2 to 8 days at a dose of 10 mg/kg actual body weight 3 to 4 times daily, intravenously.

The recommended dose of Tranexamic acid in paediatric patients is 10 mg/kg actual body weight, administered intravenously.

• The dose can be given as a single dose before tooth extractions.
• It can also be given 3 to 4 times daily for 2 to 8 days after tooth extraction 2.

From the Research

Tranexamic Acid Dosing in Paediatrics

• The recommended dosing regimen for tranexamic acid (TXA) in pediatric trauma and surgery is between 10 to 30 mg/kg loading dose followed by 5 to 10 mg/kg/h maintenance infusion rate 3.
• A study on pediatric trauma patients in the United States found that the most common initial dosing of TXA was 15 mg/kg, with a follow-up infusion of 2 mg/kg/hr × 8 hr 4.
• In pediatric cardiac surgery, a dose of 10 mg/kg of TXA was found to be effective in reducing postoperative blood loss and blood product usage 5.
• The optimal dose of TXA in pediatric scoliosis surgery is still unclear, but a high-dose regimen of 50 mg/kg loading dose with a 5 mg/kg/h maintenance dose was found to be more effective than a low-dose regimen in reducing blood loss and transfusion requirements 6.
• The dosage of TXA may vary depending on the specific clinical context and patient population, and further research is needed to determine the ideal TXA plasma therapeutic concentration for maximum efficacy and minimal side-effects 3, 7.

Clinical Contexts

• TXA has been used in various pediatric clinical contexts, including trauma, surgery, and cardiac surgery 3, 4, 5.
• The use of TXA in pediatric patients has been shown to reduce bleeding and transfusion requirements, and improve patient outcomes 3, 5, 6.
• TXA is now recommended in recent guidelines as an important part of pediatric blood management protocols 3.

Dosage Regimens

• Different dosage regimens of TXA have been used in pediatric patients, including loading doses and maintenance infusions 3, 4, 6.
• The choice of dosage regimen may depend on the specific clinical context and patient population, and further research is needed to determine the optimal dosage regimen for different clinical scenarios 3, 7.