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The Effectiveness of Tranexamic Acid in Pediatric Posttonsillectomy Hemorrhage (A Systematic Review and
Maimuna S Ahmad1, Faisal Alosamey2, Kimberly Luu2
1Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA.
Insights
Tranexamic acid (TXA) significantly reduces reoperation rates for pediatric post-tonsillectomy hemorrhage (PTH). Both IV and nebulized TXA are effective, with nebulized TXA offering practical benefits for children.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Pharmacology
Background:
- Post-tonsillectomy hemorrhage (PTH) is a common complication in pediatric patients.
- Effective management strategies for PTH are crucial to minimize morbidity.
Purpose of the Study:
- To systematically review the literature on the effectiveness of tranexamic acid (TXA) for pediatric PTH.
- To evaluate the impact of TXA on reoperation rates, blood transfusions, and adverse events.
Main Methods:
- Systematic literature search of PubMed, Embase, and Web of Science.
- Inclusion of eight studies (n=801) evaluating TXA in children aged 2-18 years.
- Primary outcome: reoperation rate for hemostasis; secondary outcomes: transfusion needs and adverse effects.
Main Results:
- TXA significantly reduced reoperation rates for PTH (pooled RR=0.62).
- No significant difference in effectiveness between intravenous and nebulized TXA routes.
- No statistically significant difference in transfusion risk and no reported adverse effects attributed to TXA.
Conclusions:
- TXA is effective in reducing reoperation rates for pediatric PTH.
- Nebulized TXA presents practical advantages for pediatric use.
- Further prospective studies are needed to optimize treatment algorithms and clinical guidelines.
Objective:
To systematically review the literature regarding the effectiveness of tranexamic acid (TXA) in the management of pediatric post-tonsillectomy hemorrhage (PTH).
Data Sources:
Comprehensive searches across PubMed, Embase, and Web of Science were conducted through December 2024 in accordance with Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines.
Review Methods:
Studies evaluating TXA (any route) for PTH in children aged 2 to 18 years were reviewed. Study characteristics, patient demographics, tonsillectomy technique, postoperative day on presentation, patient exam, route of TXA administration, and dosage were extracted. The primary outcome of interest was the rate of reoperation for hemostasis; secondary outcomes of interest included need for blood transfusion and adverse effects.
Results:
Eight studies (n = 801) met inclusion criteria. TXA administration was associated with a significant reduction in reoperation rates for hemostasis (pooled RR = 0.62, 95% CI 0.49-0.78), with no significant difference between routes of administration. There was no statistically significant difference in transfusion risk (RR = 0.76, 95% CI 0.26-9.45). Across all studies, no adverse effects attributable to TXA were reported.
Conclusion:
TXA use in managing pediatric PTH is associated with a significant reduction in reoperation rates, with both intravenous and nebulized formulations demonstrating similar effectiveness. Nebulized TXA offers practical advantages in pediatric patients and provides potential targeted oropharyngeal delivery. The available evidence is limited by retrospective study designs, small sample sizes, and risk of bias. These findings support the need for prospective studies to standardize assessment and treatment algorithms, optimize management, inform clinical practice guidelines.
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