The Efficacy of Tranexamic Acid in Pediatric Tonsillectomy: A Systematic Review and Meta-Analysis

Area of Science:

• Otolaryngology
• Pediatric Surgery
• Pharmacology

Background:

• Tonsillectomy complications, including hemorrhage, are common in children.
• Post-tonsillectomy hemorrhage (PTH) can lead to serious issues like hypovolemic shock and airway obstruction.
• Tranexamic acid (TXA) is a hemostatic agent with unclear efficacy in pediatric tonsillectomy bleeding.

Purpose of the Study:

• To determine if preoperative tranexamic acid (TXA) reduces perioperative hemorrhage in pediatric tonsillectomy.
• To systematically review randomized controlled trials (RCTs) on TXA's efficacy in reducing bleeding during tonsillectomy in children.

Main Methods:

• Systematic literature search of PubMed, Google Scholar, and CENTRAL up to June 2024.
• Included RCTs comparing preoperative TXA with a control group in pediatric patients (<18 years) undergoing tonsillectomy.
• Meta-analysis of four studies (n=380) to assess the effect of TXA on intraoperative bleeding.

Main Results:

• Meta-analysis showed no significant reduction in intraoperative bleeding with preoperative TXA (WMD = -54.44, 95% CI = -110.98 to -2.10, p=0.06).
• TXA did not demonstrate a statistically significant benefit in minimizing bleeding during the tonsillectomy procedure.
• Significant heterogeneity was observed across studies in terms of outcomes, design, and sample sizes.

Conclusions:

• Preoperative tranexamic acid (TXA) is not effective in significantly reducing intraoperative bleeding during pediatric tonsillectomy.
• Future RCTs should investigate factors like surgical techniques, TXA dosage, bleeding measurement methods, patient age, and postoperative medications.
• Further research is required to clarify the role, if any, of TXA in managing bleeding complications associated with tonsillectomy in children.