Tranexamic Acid for Management of Acute Hemorrhage in Pediatric Patients in the Emergency Department (Pharmacology CME)

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Publication Date: July 2026 (Volume 23, Number 7)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-B Credits. CME expires 07/01/2029.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Pharmacology CME credit, subject to your state and institutional approval.

Authors

Abstract

Tranexamic acid (TXA) is an antifibrinolytic medication with multiple routes of topical and systemic administration that can be used to treat acute hemorrhage across a broad range of clinical scenarios. Pediatric data are more limited than the adult literature, which benefits from larger, higher-quality studies; however, TXA remains a potentially effective, safe, and versatile option for temporizing bleeding and limiting blood loss in children. This review discusses the evidence on TXA use in traumatic hemorrhage, traumatic brain injury, posttonsillectomy bleeding, epistaxis, oral and gingival bleeding, lower airway bleeding, and traumatic hyphema.

Case Presentations

A 16-year-old boy is brought in via ambulance after being struck by a car while riding his bicycle...

• The patient was helmeted and did not experience loss of consciousness.
• On examination, he is alert but pale and complaining of significant abdominal pain. His vital signs are: temperature, 36.7°C; heart rate, 135 beats/min; blood pressure, 90/60 mm Hg; respiratory rate, 18 breaths/min; and oxygen saturation, 98% on room air. Aside from diffuse abrasions of the extremities, the secondary survey is notable for a tender abdomen with right-sided ecchymoses. A focused assessment with sonography in trauma examination is positive for hepatorenal and pelvic free fluid.
• After obtaining IV access, you initiate a blood transfusion and activate the massive transfusion protocol.
• While waiting for the trauma surgery team, you wonder if there are therapies you should initiate to improve bleeding control. If so, what is the proper dosing regimen?

A 4-year-old girl who had a tonsillectomy 7 days prior presents following an episode of hematemesis at home, approximately 20 minutes ago...

• The patient is awake and alert, although mildly anxious appearing. Her vital signs are appropriate for age. There is some oozing of fresh red blood around the right tonsillar pillar. The nurse obtains prompt IV access and laboratory studies.
• You consult otorhinolaryngology, who recommends the patient gargle ice water until they can evaluate her. You have concerns that the patient may not be able to perform this safely and effectively.
• Are there other developmentally appropriate measures that can be used to help temporize bleeding?

A 7-year-old boy presents with persistent left-sided epistaxis for the past 30 minutes that began after he was “picking his nose”...

• The triage nurse instructed the patient’s mother to tilt his head forward and pinch the distal end of his nose. After 10 minutes, the nosebleed persists. There is moderate bright-red blood in the left nostril.
• No foreign bodies or other pathology are visualized on examination. The boy’s vital signs and the remainder of the physical examination are otherwise unremarkable.
• The pediatrics resident orders oxymetazoline nasal spray and says that if the bleeding persists after this treatment, then otorhinolaryngology will need to cauterize the bleeding site.
• You wonder if there are other topical treatment options that can be tried for this patient’s nosebleed before cauterization. If so, how should they be prepared?

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.