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Studies included patients under 18\u2009years of age, non\u2010cardiac surgery, and administration of antifibrinolytics. Forest plots were used for statistical analysis. Primary outcomes were intraoperative blood loss and intraoperative blood transfusions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One hundred thirty articles met inclusion. Tranexamic acid compared to control resulted in an estimated blood loss of \u2212410.0\u2009mL <jats:italic>p<\/jats:italic>\u2010value\u2009=\u2009&lt;\u20090.001 for scoliosis surgery, \u221214.0\u2009mL\/kg <jats:italic>p<\/jats:italic>\u2010value\u2009=\u2009&lt;\u20090.001 for craniofacial surgery, and \u221221.0\u2009mL <jats:italic>p<\/jats:italic>\u2010value &lt;\u20090.001 for tonsillectomy\/adenoidectomy surgery. Aminocaproic acid compared to control resulted in an estimated blood loss of \u2212464.0\u2009mL <jats:italic>p<\/jats:italic>\u2010value &lt;\u20090.001 for scoliosis surgery. Tranexamic acid compared to aminocaproic acid resulted in an estimated blood loss of \u2212391.0\u2009mL <jats:italic>p<\/jats:italic>\u2010value &lt;\u20090.001 for scoliosis surgery. For blood transfusion during craniosynostosis surgery, tranexamic acid compared to control resulted in a mean decrease of \u22127\u2009mL\/kg <jats:italic>p<\/jats:italic>\u2010value\u2009=\u20090.010 and aprotinin compared to control resulted in a mean decrease of \u221220.0\u2009mL\/kg <jats:italic>p<\/jats:italic>\u2010value &lt;\u20090.001. The analysis for VRO\/VDRO and hip reconstruction did not reach statistical significance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In craniofacial, scoliosis, and tonsillectomy\/adenoidectomy surgery, prophylactic administration of tranexamic acid results in lower estimated blood loss. Tranexamic acid and aprotinin are effective for reducing transfusion in craniofacial surgery. For scoliosis surgery, tranexamic acid is more efficacious than aminocaproic acid. More literature is needed to assess the efficacy of tranexamic acid in VRDO\/VRO and hip reconstruction surgery and the efficacy of different dosing regimens.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.15137","type":"journal-article","created":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T08:14:10Z","timestamp":1749197650000},"page":"668-683","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The Effect of Prophylactic Use of Antifibrinolytics During Pediatric Non\u2010Cardiac Surgeries on Bleeding and Transfusions: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-7581-454X","authenticated-orcid":false,"given":"Katherine Schertz","family":"Hickey","sequence":"first","affiliation":[{"name":"Department of Pediatric Critical Care Mount Sinai Kravis Children's Hospital  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morgan","family":"Smith","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care, Department of Pediatrics New York\u2010Presbyterian\/Weill Cornell Medicine  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6606-1736","authenticated-orcid":false,"given":"Oliver","family":"Karam","sequence":"additional","affiliation":[{"name":"Pediatric Critical Care Medicine, Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Demetres","sequence":"additional","affiliation":[{"name":"Samuel J. 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