Antifibrinolytic drugs are used to reduce blood loss and subsequent transfusions during surgery and following trauma, but the optimal dosing regimen in the pediatric population is still unresolved. The aim of this systematic review was to evaluate efficacy and safety of antifibrinolytic drugs in pediatric surgery and trauma to determine the optimal dosing regimen. A literature search was performed in PubMed, Embase, Cochrane, and Web of Science on May 3, 2020. We included randomized controlled studies investigating the effect of tranexamic acid (TXA), aprotinin, and epsilon-aminocaproic acid, in terms of reducing blood loss, blood transfusions, reoperations, and rebleeds in pediatric patients aged 0 to 18 years undergoing cardiac surgery, noncardiac surgery, or trauma. Fifty randomized controlled trials (RCTs) were included; 28 RCTs investigated cardiac surgery and 22 investigated noncardiac surgery. No RCTs regarding trauma met the inclusion criteria. All antifibrinolytic drugs reduced postoperative blood loss and transfusions when used in pediatric surgery. The dosing regimen varied between studies, but similar effect sizes were found in terms of reduced blood loss regardless of the cumulative dose used. Few studies found adverse events, and no difference in incidence or type of adverse events was seen between the antifibrinolytic and the placebo group. In conclusion, use of antifibrinolytics is efficient and safe in children undergoing surgery. We propose TXA as the drug of choice based on its level of evidence and safety profile; we recommend a dosing regimen composed of a loading dose of 10 to 15 mg/kg prior to surgery followed by 1 to 5 mg/kg/h as continuous infusion throughout surgery.

抗纤溶药物用于减少手术期间和创伤后的失血和随后的输血，但儿科人群的最佳给药方案仍未解决。本系统评价的目的是评估抗纤溶药物在儿科手术和创伤中的有效性和安全性，以确定最佳给药方案。于 2020 年 5 月 3 日在 PubMed、Embase、Cochrane 和 Web of Science 中进行了文献检索。我们纳入了随机对照研究，调查了氨甲环酸 (TXA)、抑肽酶和ε-氨基己酸在降低血0 至 18 岁接受心脏手术、非心脏手术或外伤的儿科患者的丢失、输血、再次手术和再出血。纳入了 50 项随机对照试验 (RCT)；28 项 RCT 研究了心脏手术，22 项研究了非心脏手术。没有关于创伤的随机对照试验符合纳入标准。当用于小儿外科手术时，所有抗纤溶药物都减少了术后失血量和输血。给药方案因研究而异，但无论使用的累积剂量如何，在减少失血方面都发现了相似的效果大小。很少有研究发现不良事件，抗纤溶组和安慰剂组在不良事件的发生率或类型上没有差异。总之，在接受手术的儿童中使用抗纤溶药物是有效和安全的。我们建议 TXA 作为首选药物，基于其证据水平和安全性；