The Utility and Safety of Prophylactic Tranexamic Acid in Tonsillectomy: A Systematic Review and Meta-analysis

We conducted a systematic review of randomized controlled trials (RCTs) to evaluate the efficacy of tranexamic acid (TXA) in reducing posttonsillectomy hemorrhage (PTH).

We searched MEDLINE, EMBASE, and CENTRAL for RCT comparing prophylactic TXA to control in patients undergoing tonsillectomy.

Per Preferred Reporting Items for Systematic Review and Meta-analysis guidelines, the databases were searched from date of inception through October 2023. RCTs of patients undergoing tonsillectomy or adenotonsillectomy and receiving prophylactic TXA versus control were included. Two reviewers screened citations, extracted data, assessed the risk of bias, and classification of Grading of Recommendations, Assessment, Development, and Evaluation independently. Standardized mean difference with 95% confidence interval (CI) was applied for continuous variables. Dichotomous data were expressed as relative risk with 95% CI.

A total of 10 RCT were included in our quantitative analysis. Eight studies reported on PTH rate. Prophylactic TXA showed non-significant decrease in PTH (relative risk or risk ratio [RR]: 0.62 [0.35, 1.10]). Sensitivity analysis showed significant decrease in PTH after exclusion of High-risk bias studies (RR: 0.48 [0.30, 0.77]). Intraoperative blood loss volume was significantly lower in the TXA group (35.59 mL [-48.19, -22.99]).

Overall, this study showed a tendency toward lesser PTH rate with prophylactic TXA. However, this tendency only reaches statistical significance when studies with high risk of bias are excluded. Well-designed trials are still needed to support our observations.