Abstract

Tranexamic acid (TXA) is a synthetic antifibrinolytic agent that inhibits fibrinolysis without promoting new clot formation. Although FDA-approved for limited indications, TXA is frequently used off-label to reduce perioperative blood loss. Its use is well established in adult populations; however, pediatric data remain limited. Available evidence demonstrates that TXA effectively decreases intraoperative blood loss and transfusion requirements. This case involves an 8-year-old female with Lennox-Gastaut syndrome undergoing a right hip triple osteotomy with spica casting. The patient had a history of significant surgical blood loss resulting in hypotension and transfusion. Given the history, TXA was incorporated into the anesthetic plan, with a 285 mg bolus administered over 15 minutes followed by a 5mg/kg/hr infusion for the duration of surgery.

This lead to this clinical question: In pediatric patients having non-trauma related procedures with anticipated significant blood loss, does TXA compared to no TXA improve hemostasis with no increased adverse outcomes during the intraoperative and first 48-hour postoperative periods?

The literature supports TXA as an effective blood conservation strategy in pediatric surgical patients, demonstrating reductions in transfusion rates from 28-75% without TXA to 17-49% with TXA. Studies indicate a favorable safety profile when conservative dosing is used. In patients with increased transfusion risk, TXA reduces exposure to allogeneic blood products and associated morbidity.

Current evidence supports incorporating TXA into standardized anesthetic protocols for non-trauma pediatric surgeries with anticipated blood loss. Recommended dosing includes a 10-15 mg/kg loading dose followed by a 5 mg/kg/hr infusion.

Author Details

Hannah Lee, DNP(c), BSN, RN and Lisa Herbinger, DNP, CRNA, FAANA

Sigma Membership

Non-member

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Case Study/Series

Research Approach

Translational Research/Evidence-based Practice

Keywords:

Tranexamic Acid, TXA, Pediatric Surgery, Non-Trauma Related Hemorrhage, Perioperative Blood Loss, Hemorrhage

Advisor

Lisa Herbinger

Second Advisor

David Sanford

Degree

DNP

Degree Grantor

Samford University

Degree Year

2026

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Proxy-submission

Date of Issue

2026-02-04

Full Text of Presentation

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Additional Files

Abstract.pdf (72 kB)

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