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

Post-tonsillectomy bleeding (PTB) is the leading cause of re-operation and mortality following tonsillectomy. Tranexamic acid (TXA) has been widely utilized in various medical fields to manage bleeding. However, its efficacy in preventing bleeding after tonsillectomy remains uncertain. This study aimed to assess the effectiveness of systemic (intravenous or oral) TXA in reducing the incidence of secondary PTB post-tonsillectomy.

A retrospective cohort study at the Ambulatory Care Center in Qatar evaluated patients undergoing tonsillectomy from January 2021 to January 2024. Chi-square and multilogistic regression analyses were used to examine the relationship between TXA use and secondary PTB incidence.

A total of 2314 patients were evaluated, primarily pediatrics (89.1%), Arabic (89.3%), and male (57.5%). TXA was prescribed post-tonsillectomy for 233 patients (10.1%), with intraoperative use in 44 patients (1.9%). No significant difference in incidence of secondary PTB was observed between control group and TXA use post-tonsillectomy (5.0% vs 3.9%, P = 0.52). Among 114 secondary PTB cases, the mean hemoglobin drop was 1.7 (2.1) in the non-TXA group and 0.93 (1.2) in the TXA group (P = 0.23). Surgical intervention was needed in 24% of non-TXA patients (P = 0.11). Rates of blood transfusion, ICU admission, and significant hemoglobin drop were similar. TXA post-tonsillectomy did not significantly reduce PTB odds (OR 0.18, P = 0.13), but composite data of either intraoperative or discharge TXA administration significantly reduced PTB odds (OR 0.03, P = 0.004).

Post-tonsillectomy use of TXA did not significantly reduce secondary PTB but showed a nonsignificant trend towards less surgical reintervention. Composite of either intraoperative or discharge TXA significantly lowered PTB odds, suggesting potential benefits that warrant confirmation through larger studies.