Does tranexamic acid have role in controlling intraoperative blood loss in tonsillectomy?

Abstract

<p class="abstract"><strong>Background:</strong> The study was done with the objective to assess the effect of tranexamic acid in controlling intraoperative bleeding in tonsillectomy.</p><p class="abstract"><strong>Methods:</strong> Retrospective study was conducted in the Department of ENT and HNS, Tribhuvan University Teaching Hospital, Kathmandu, Nepal from August 2016 to July 2017. Patients more than 15 years who underwent bilateral tonsillectomy were included in the study. Whereas patients who underwent unilateral tonsillectomy and patients who had hypersensitivity to tranexamic acid were excluded from the study. The patients who received tranexamic acid during surgery were taken as study group whereas the patients who didn’t receive tranexamic acid were taken as control. The amount of the intraoperative blood loss, i.e. mean and the frequency of early post-operative bleeding were evaluated. </p><p class="abstract"><strong>Results:</strong> A total of 48 patients who fulfilled the inclusion criteria were evaluated. Among whom, 24 patients who received tranexamic acid during tonsillectomy were taken as study group and other 24 patients who did not received tranexamic acid were taken as control. The mean blood loss in study and control group were 92.85 ml and 91.40 ml respectively and the difference was statistically not significant (p=0.785). There were no cases of early postoperative bleeding recorded in either group within the first 24 hours of surgery.</p><p><strong>Conclusions:</strong> There is no significant role of tranexamic acid in controlling intraoperative bleeding in tonsillectomy. </p>

A systematic review on the efficacy of tranexamic acid in head and neck surgery

“…Achakzai et al 30 similarly reported a reduction of 29.59 mL in their study group. Pukhlik et al 29 reported a much lower reduction at 19 mL. However, all these reductions were found to be statistically significant.…”

“…Five tonsillectomy studies reported on mean intraoperative blood loss (mL). [23][24][25]29,30 Four out of these five studies reported significant reduction in the volume of intraoperative blood loss. [23][24][25]30 Santosh et al 23 reported a mean reduction of 40.72 mL in their study group while George et al 24 reported a reduction of 29.68 mL.…”

“…into two main categories-8 out of the 16 studies were identified to be major H&N surgical studies [6][7][8][18][19][20][21][22] while the other 8 were tonsillectomy studies. [23][24][25][26][27][28][29][30] The characteristics of the studies for the tonsillectomy studies are defined in Table 4 and for the H&N studies in Table 5, including a breakdown of the type of H&N operations undertaken. There were 941 patients in the H&N studies and there 113 466 patients in the tonsillectomy studies.…”

The efficacy of Tranexamic Acid Administration in Patients Undergoing Tonsillectomy: An Updated Meta-Analysis

“…No evidence of heterogeneity across these studies were detected ( I 2 = 0%). The study by Dutta et al 17 reported no patients with postoperative hemorrhage in either the control or TXA group.…”

“…Based on the NOS, all non-randomized studies 17,18,20,22,23,26 received a score between 6 and 8, indicating that they had fair methodological quality (Table 4). Most of the RCTs 19,21,24,25 had a low risk of bias (Figure 2), except for the study conducted by Castelli and Vogt 25 due to poor blinding of participants and personnel.…”