Post-tonsillectomy hemorrhage control with nebulized tranexamic acid: A retrospective cohort study

Erwin, Dylan Z.; Heichel, Philip D.; Bs, Laura M. Wright; Goldstein, Nira A.; McEvoy, Timothy P.; Earley, Marisa; Meyer, Andrew

doi:10.1016/j.ijporl.2021.110802

Cited by 10 publications

(13 citation statements)

References 28 publications

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“…31 Three out of these nine studies reported a clinically significant impact of TXA. 20,21,28 Babu et al 21 demonstrated a significant clinical reduction in the number of blood transfusion in the TXA group (p < 0.011) and interestingly divided their patients into two groups with different dosages of TXA (10 and 15 mg/kg in volume of 20 mL). They found that it made no difference to the volume of blood loss between the difference concentrations ( p = 0.706).…”

Section: The Clinical Impact Of Txamentioning

confidence: 99%

“…In the cohort that received intravenous TXA, none of the cases required re-intervention postoperatively whereas the control cohort illustrated that five of those cases required reintervention ( p = 0.041). Erwin et al 28 was another randomised trial that proved clinical efficacy of TXA and the only tonsillectomy study that reported a significant reduction in posttonsillectomy secondary haemorrhage incidents (p = 0.005) in the TXA group.…”

Section: The Clinical Impact Of Txamentioning

confidence: 99%

“…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.…”

Section: The Rates Of Secondary Posttonsillectomy Haemorrhagementioning

confidence: 99%

“…Ten studies reported on the requirement of blood transfusions or the number of re-interventions or the incidences of postoperative haemorrhages. 7,8,18,20,21,[25][26][27][28][29] Heterogeneity amongst outcome assessment precluded meta-analysis. 31 Three out of these nine studies reported a clinically significant impact of TXA.…”

Section: The Clinical Impact Of Txamentioning

confidence: 99%

“…Topical TXA 18,22 and nebulised TXA 28 were illustrated to be more promising with a clinically significant reduction in the hospital stay of patients. However, since there were a limited number of studies exploring these routes and only one of them was an RCT, 18 the current evidence remains inadequate to establish the efficacy of topical and nebulised TXA in H&N patients.…”

Section: Future Researchmentioning

confidence: 99%

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

Jamshaid

Coulson

et al. 2023

Clinical Otolaryngology

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Background Intraoperative and postoperative blood loss is a major risk in head and neck (H&N) surgery. Recently the use of tranexamic acid (TXA) has been investigated by multiple studies for reducing intraoperative and postoperative bleeding, however reported results are variable. Objectives To determine the safety and efficacy of TXA use in H&N surgery. Methods Systematic review of MEDLINE, EMBASE, CINAHL, Cochrane Library, PubMed, ClinicalKey, and Clinicaltrials.gov according to the PRISMA guidelines. Studies were included if they reported on intraoperative bleeding, volume or duration of postoperative drain or return to theatre rate for postoperative haemorrhage in adult populations following use of TXA. Risk of bias assessment with Cochrane Risk of Bias (RoB2) tool for randomised controlled trials and Newcastle–Ottawa Scale tool for non‐randomised studies. Results Sixteen studies were identified (114 407 patients). Eight studies evaluated TXA in major H&N surgery and eight studies in tonsillectomy. Primary outcomes were reduction in intraoperative or postoperative bleeding. Secondary outcomes included the duration of postoperative drain placement and return to theatre rate. No adverse events were reported in any patients. TXA is effective in reducing intraoperative blood loss in tonsillectomy. However, the effect on posttonsillectomy haemorrhage was unclear. Insufficient evidence exists of benefit of TXA on intraoperative bleeding in major H&N procedures. Postoperative drainage volumes were significantly reduced in most major H&N studies. The duration of drain placement and risk of blood transfusion was unchanged in most cases. Conclusion TXA use is safe in H&N patients. Whilst sufficient evidence exists to support the use of TXA in tonsillectomy, insufficient evidence exists to recommend use in major H&N surgery.

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