# Tranexamic acid dosing in pediatric trauma: Dose simulation based on population pharmacokinetic modeling in adult trauma patients

## TL;DR

Researchers simulated TXA dosing in children to match adult exposure, finding a 25 mg/kg dose achieves similar peak levels but may require more frequent administration.

## Contribution

This study provides a novel pediatric TXA dosing strategy based on adult pharmacokinetic modeling.

## Key findings

- A 25 mg/kg TXA bolus in children approximates adult Cmax after a 2 g dose.
- Doses between 20–35 mg/kg failed to match adult AUC0–4h or AUC0–8h.
- More frequent dosing may be needed in children to match adult drug exposure.

## Abstract

Trauma is the most common cause of death in children >1 year of age, with hemorrhage being the most common preventable cause of death after injury. Antifibrinolytics like tranexamic acid (TXA) are a key aspect of trauma management in children, but optimal dosing remains unknown. The objective of this study was to derive a TXA dose in children with trauma‐related bleeding that approximates the TXA exposure in adult trauma patients using a population pharmacokinetic (popPK) model from adults with severe traumatic injury.

Model‐based simulation was performed by extrapolating a previously published popPK model of TXA in adults with trauma‐related bleeding to pediatric patients. A virtual pediatric trauma population was simulated utilizing published covariate values and an allometrically scaled adult model applied to predict the TXA PK profile in children with trauma‐related bleeding.

An IV TXA bolus of 25 mg/kg (max 2 g) in children with trauma‐related bleeding approximates the Cmax after a 2 g IV bolus in an adult trauma population. No dose from 20 to 35 mg/kg achieved the AUC0–4h or AUC0–8h that results from a 2 g IV bolus in adults.

In children with trauma‐related bleeding, a TXA 25 mg/kg IV bolus is predicted to approximate the Cmax achieved with a 2 g IV bolus in adults. More frequent dosing may be necessary in children to achieve a similar total drug exposure as adults with trauma‐related bleeding.