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

The aim of this study is to determine whether nebulized tranexamic acid (TXA) is effective and safe in controlling post-tonsillectomy hemorrhage (PTH) and to analyze factors that are associated with surgical hemostatic control.

A retrospective chart review was performed of all patients younger than 18 years of age presenting with PTH from January 2019 until October 2023. Demographic and clinical data was collected and included indication for tonsillectomy, pharyngeal exam at presentation, hematologic work-up, American Society of Anesthesiologists physical status classification, treatment modalities including nebulized TXA use and surgical control of bleeding, length of stay and readmission rate.

A total of 287 patients with a median age of 6.3 years were included. The TXA group included 100 (34.8 %) patients and the no TXA group included 187 (65.2 %) patients. A lower percentage of patients required surgical control of bleeding in the TXA group compared to the no TXA group (26.0 % vs 41.7 %, p-value = 0.010). While controlling for active bleeding and clot on exam, TXA showed a reduction of 75 % in the odds of surgical intervention for PTH (OR = 0.25 [95 % CI: 0.13, 0.48, p-value=<0.001]). The median length of hospital stay was one night for both groups. Readmission rates for rebleeding were also similar in both groups (TXA group 9.0 % vs no TXA group 7.0 %, p-value = 0.518). No complications attributable to nebulized TXA administration were noted.

Nebulized TXA holds promise to be an effective and safe modality for the management of post-tonsillectomy hemorrhage.