Tranexamic acid and post-tonsillectomy hemorrhage: propensity score and instrumental variable analyses

Area of Science:

• Otolaryngology
• Surgical Hemorrhage Control
• Pharmacological Interventions

Background:

• Post-tonsillectomy hemorrhage is a rare but potentially life-threatening complication.
• Previous studies on tranexamic acid (TXA) efficacy were limited by small sample sizes.
• The effectiveness of TXA in preventing post-tonsillectomy bleeding requires further investigation.

Purpose of the Study:

• To evaluate the effectiveness of tranexamic acid (TXA) in preventing post-tonsillectomy hemorrhage.
• To analyze TXA's impact on reoperation and blood transfusion rates using a nationwide database.
• To identify risk factors associated with post-tonsillectomy hemorrhage.

Main Methods:

• Retrospective cohort study utilizing the Diagnosis Procedure Combination database in Japan (2010-2016).
• Inclusion of 117,598 patients who underwent tonsillectomy across 750 hospitals.
• Propensity score-matched and instrumental variable analyses were performed.

Main Results:

• No significant difference in reoperation or blood transfusion rates between TXA treatment and control groups (1.50% vs. 1.47%, p=0.64).
• Instrumental variable analysis confirmed no significant association (OR, 0.98; 95% CI, 0.86-1.13; p=0.82).
• Factors associated with increased hemorrhage risk included male sex, older age, emergency hospitalization, prolonged anesthesia, and medium hospital volume.

Conclusions:

• Administration of TXA from the day of tonsillectomy is not associated with a reduction in reoperation or blood transfusion rates.
• The findings suggest TXA may not be effective in preventing hemorrhage after tonsillectomy.
• Male sex, older age, and specific hospital/procedural factors are linked to higher hemorrhage risk.