Tranexamic Acid for Preventing Secondary Post-Tonsillectomy Bleeding: Insights From A Retrospective Cohort Study

Area of Science:

• Otolaryngology
• Pharmacology
• Surgical Safety

Background:

• Post-tonsillectomy bleeding (PTB) is a significant complication, leading to re-operations and mortality.
• Tranexamic acid (TXA), an antifibrinolytic agent, is used to manage bleeding in various settings.
• The effectiveness of systemic TXA in preventing PTB remains unclear.

Purpose of the Study:

• To evaluate the efficacy of systemic (intravenous or oral) tranexamic acid (TXA) in reducing secondary post-tonsillectomy bleeding (PTB).
• To assess the impact of TXA on the need for surgical reintervention, blood transfusion, ICU admission, and hemoglobin drop.

Main Methods:

• Retrospective cohort study conducted at an Ambulatory Care Center in Qatar (January 2021 - January 2024).
• Analysis included 2314 patients undergoing tonsillectomy.
• Chi-square and multilogistic regression analyses were employed to determine the association between TXA use and PTB incidence.

Main Results:

• No significant difference in secondary PTB incidence was found between patients who received post-tonsillectomy TXA and those who did not (5.0% vs 3.9%, P=0.52).
• TXA use did not significantly reduce the odds of PTB (OR 0.18, P=0.13).
• However, composite data combining intraoperative or discharge TXA administration significantly reduced PTB odds (OR 0.03, P=0.004).

Conclusions:

• Systemic TXA administered post-tonsillectomy did not significantly decrease secondary PTB rates.
• A trend towards less surgical reintervention was observed with TXA use.
• Combined intraoperative or discharge TXA administration showed a significant reduction in PTB odds, warranting further investigation in larger studies.