Current Guidelines and Considerations on the Use of Tranexamic Acid (TXA) in Pediatric and Obstetric Trauma: A Review

Abstract

Tranexamic acid (TXA), an antifibrinolytic agent, has shown significant promise in reducing hemorrhage-related morbidity and mortality, particularly in adult trauma and postpartum hemorrhage. However, its role in pediatric and obstetric trauma remains less clearly defined due to limited high-quality evidence and the unique physiological characteristics of these populations. This review examines current guidelines, clinical trials, and observational data supporting tranexamic acid use in pediatric and obstetric trauma settings. In pediatric trauma, studies like Pediatric Trauma and Tranexamic Acid Study (PED-TRAX) and Traumatic Injury Clinical Trial Evaluating Tranexamic Acid in Children (TIC-TOC) suggest potential mortality benefits with low thromboembolic risk, although data are primarily observational and dosing strategies remain inconsistent. In obstetric trauma, robust evidence—especially from the World Maternal Antifibrinolytic (WOMAN) Trial—supports early tranexamic acid administration for postpartum hemorrhage, leading to international guideline endorsements. Despite these advancements, concerns persist regarding optimal dosing, long-term safety, fetal outcomes, and real-world implementation. Addressing these gaps through pediatric- and obstetric-specific randomized trials, standardized protocols, and system-level interventions is essential to optimizing the safe and effective use of tranexamic acid in these vulnerable populations.