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

Maximum Dose of Tranexamic Acid in Pediatric Patients

The maximum dose of tranexamic acid (TXA) for pediatric patients is 15-25 mg/kg per dose, not exceeding 3-4 g per day total. 1, 2

Dosing by Clinical Scenario

Trauma and Surgery

• For trauma and surgical procedures, the recommended dosing is 15 mg/kg loading dose followed by 2 mg/kg/hour infusion 1, 3
• This dosing regimen is widely used in pediatric trauma centers across the United States, with 68% of centers using 15 mg/kg as the initial dose 3
• Most centers (87%) follow the loading dose with a maintenance infusion, typically at 2 mg/kg/hour for 8 hours 3

Menorrhagia in Adolescents

• For menorrhagia, the recommended dose is 30-50 mg/kg/day divided into 2-3 doses, with a maximum daily dose of 3-4 g 1, 2
• For severe cases requiring IV treatment, the dose is 15 mg/kg followed by 2 mg/kg/hour infusion 2

Hereditary Angioedema Prophylaxis

• Maximum dose of 15-25 mg/kg two to three times daily, not exceeding 3 g/day total 1, 2

Topical Application

• For topical application in gauze soaks, the concentration is 500 mg in 5 mL (100 mg/mL) 2, 4

Safety Considerations

• TXA should be administered as early as possible in trauma cases, ideally within 3 hours of injury 1
• Delaying TXA administration reduces benefit by approximately 10% for every 15 minutes 1
• Administration beyond 3 hours after trauma may potentially be harmful rather than beneficial 1
• Recent studies have shown that prehospital TXA administration in pediatric trauma patients is feasible with an adverse event rate under 5% 5
• Dose adjustment is necessary for pediatric patients with renal impairment 2
• Relative contraindications include recent thrombosis, atrial fibrillation, or known thrombophilia 2

Clinical Pearls

• Using fixed adult doses in pediatric patients without weight-based calculation can lead to under or overdosing 1
• Recent research suggests that a dosing regimen between 10-30 mg/kg loading dose followed by 5-10 mg/kg/h maintenance infusion rate may be optimal for pediatric trauma and surgery 6
• Despite its proven efficacy in adult trauma patients, TXA is still relatively underutilized in pediatric trauma cases, with only 0.31% of pediatric TXA administrations being for traumatic conditions 7
• TXA is considered a low-cost, low-risk therapy with high potential benefit for pediatric trauma patients with significant bleeding risk 3
• TXA is included in the World Health Organization's list of essential medicines due to its value in reducing almost any kind of bleeding 8