Evaluation of Nebulized Tranexamic Acid for Acute Secondary Posttonsillectomy Hemorrhage

Determine the efficacy of nebulized TXA for secondary posttonsillectomy hemorrhage.

Retrospective cohort study.

Tertiary care medical center.

All adult and pediatric patients who presented with active posttonsillectomy hemorrhage >24 hours posttonsillectomy treated at our tertiary care institution between December 2014 and July 2025 were included. Patients who were not actively bleeding on presentation were excluded. Outcomes were compared between patients who received nebulized TXA and those who did not. Outcomes included need for operative intervention, length of hospital stay, and recurrent hemorrhage rate. Univariate statistical analysis was performed using SPSS.

There were 101 patients included and 57 received nebulized TXA. All included patients were actively bleeding at the time of initial presentation. Hemostasis was achieved in 84.2% of the 57 patients following administration of nebulized TXA. Patients who received nebulized TXA were significantly less likely to require operative intervention (OR = 0.370 [0.157-0.873]). If operative intervention was required following administration of nebulized TXA (54.9%), the time from presentation to operative intervention was significantly longer (408 ± 324 minutes vs 249 ± 293 minutes, P = .045). Neither hospital length of stay (1.2 ± 1.1 vs 1.5 ± 1.4 days, P = .148) or readmission rate for recurrent posttonsillectomy hemorrhage (7.0% vs 13.6%, P = .283) differed significantly between groups. No adverse effects of nebulized TXA were identified.

Administration of nebulized TXA is a safe and effective strategy for acute stabilization of secondary posttonsillectomy hemorrhage. Nebulized TXA reduced the rate of operative intervention for secondary posttonsillectomy hemorrhage and increased the time until intervention was required.