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A Journal on Otorhinolaryngology, Head and Neck Surgery,
Plastic Reconstructive Surgery, Otoneurosurgery
Indexed/Abstracted in: EMBASE, Scopus
Otorinolaringologia 2013 December;63(4):163-7
Can tranexamic acid reduce bleeding after tonsillectomy? A pilot study
Robb P. J. 1, Ewah B. 2
1 ENT Department Epsom and St Helier University Hospitals, Epsom, UK;
2 Department of Anesthesia Epsom and St Helier University Hospitals, Epsom, UK
Aim: The most significant, common complication following tonsillectomy is hemorrhage. Tranexamic acid (TXA), a synthetic anti-fibrinolytic has been widely used to limit bleeding during surgery and following multi-trauma. In this pilot study of adults undergoing tonsillectomy, we wished to assess any effect of TXA administered as a single intravenous dose during surgery and for ten days orally on post operative bleeding after tonsillectomy.
Methods: A prospective pilot study of adults undergoing elective day case Coblation™ tonsillectomy for recurrent tonsillitis between January 2007 and January 2013. Outcomes for postoperative bleeding were compared with data from the UK National Prospective Tonsillectomy Audit.
Results: During the study period, 112 adults underwent elective day case tonsillectomy for recurrent tonsillitis. There were no reactionary hemorrhages. No patients required readmission, return to theatre or blood transfusion following tonsillectomy. During the second postoperative week, three patients reported producing blood stained saliva and one patient spat up a small volume of fresh blood. None of these sought medical advice for these minor, self-limiting episodes. Two patients experienced nausea using the TXA, one enough to discontinue the medication. One patient was excluded from this study because she had a familial protein S deficiency, a relative contraindication to antifibrinolytic medication.
Conclusion: This observational pilot study demonstrates that TXA may reduce both frequency and severity of postoperative bleeding following tonsillectomy. These preliminary findings warrant further investigation with a large, prospective randomised trial.