Nebulized Tranexamic Acid for the Control of Pediatric Post-tonsillectomy Hemorrhage

Area of Science:

• Otolaryngology
• Pediatric Surgery
• Pharmacology

Background:

• Post-tonsillectomy hemorrhage (PTH) is a common complication in pediatric patients.
• Effective hemostatic control is crucial to minimize morbidity and healthcare costs.
• Current management strategies for PTH vary, necessitating evaluation of novel therapeutic options.

Purpose of the Study:

• To evaluate the efficacy and safety of nebulized tranexamic acid (TXA) in managing pediatric post-tonsillectomy hemorrhage.
• To identify factors associated with the need for surgical hemostatic control in PTH.
• To compare outcomes between patients treated with and without nebulized TXA.

Main Methods:

• Retrospective chart review of pediatric patients (<18 years) with PTH from January 2019 to October 2023.
• Data collected included patient demographics, clinical presentation, treatment modalities (nebulized TXA, surgical control), length of stay, and readmission rates.
• Statistical analysis was performed to compare outcomes between TXA and no-TXA groups and to identify predictors of surgical intervention.

Main Results:

• A total of 287 patients were analyzed; 100 received nebulized TXA.
• The TXA group showed a significantly lower rate of surgical intervention (26.0% vs. 41.7%, p=0.010).
• Nebulized TXA reduced the odds of requiring surgery by 75% (OR=0.25, p<0.001), with no reported complications. Length of stay and readmission rates were similar between groups.

Conclusions:

• Nebulized tranexamic acid (TXA) is an effective and safe adjunctive therapy for controlling pediatric post-tonsillectomy hemorrhage.
• TXA administration may significantly decrease the need for surgical intervention in PTH.
• Further prospective studies are warranted to confirm these findings and establish optimal protocols.