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

Abstract

Objective: There is controversy regarding the efficacy and safety of tranexamic acid (TXA) in reducing tonsillectomy-related hemorrhage. We conducted a systematic review and meta-analysis to evaluate the prophylactic role of TXA in tonsillectomy. Methods: We searched 6 databases to identify studies that directly compare the effect of TXA versus controls in tonsillectomy patients. Standardized mean difference was applied to summate the findings across the studies. Dichotomous data were expressed as relative risk. Results: Ten studies representing a total of 111 898 patients were included. The pooled results showed a significant reduction of intraoperative blood loss by 39.02 ml (SMD = −1.05, 95% CI: −1.91 to −0.20, P = .016) and the rate of post-tonsillectomy hemorrhage (RR = 0.42, 95% CI: 0.28 to 0.65, P < .0001), with no significant difference in reduction of further intervention risk (RR = 0.78, 95% CI: 0.45 to 1.35, P = .373). Conclusions: Overall, this study indicates that TXA may reduce blood loss and frequency of post-operative hemorrhage associated with tonsillectomy. Further large, high-quality clinical trials are still needed to explore TXA’s effect on post-tonsillectomy hemorrhage and the safety of its use.

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“…Koisumi reveals that the use of tranexamic acid in the day of surgery did not reduce post-tonsillectomy bleeding [15], in contrast; Kuo in his meta-analysis showed significant reduction in blood loss intra operative and in the rate of post-tonsillectomy bleeding with RR of 0.42 [16], similar data were demonstrated by Liu, being less effective when applied topically [17].…”

The Effect of Tranexamic Acid Local Injection on Bleeding during and after Tonsillectomy: A Double-Blind Randomized Placebo-Controlled Trial

“…On the other hand, compared to an intravenous TXA dose of 5 mg/kg, less bleeding occurred with a 10 mg/kg dose 17 . In addition, in an updated meta-analysis, oral or intravenous TXA significantly reduced intraoperative blood loss and the rate of post-tonsillectomy hemorrhage 6 .…”

“…Tranexamic acid (TXA), a synthetic analogue of the amino acid lysine, has also been introduced for controlling tonsillectomy-related bleeding 6 . By competitively binding to the lysine-binding sites on plasmin and plasminogen, TXA enhances anti-fibrinolysis 7 .…”

“…TXA significantly reduces the intra-operative blood loss volume and post-operative hemorrhage rate in patients who undergo tonsillectomy 6 , but TXA was used orally or intravenously in all ten studies included in this meta-analysis. Systemic TXA side effects include gastrointestinal (such as nausea, diarrhea, and cramps) when taken orally, concern for renal toxicity in individuals with impaired kidney function, hypotension after rapid delivery, and seizures at dosages beyond what is considered therapeutic 9 .…”

Does infection play a role in post-tonsillectomy haemorrhage? A narrative review

“…104 However, a recently published update of this review compromising 10 randomised, controlled trials was more promising, with pooled meta-analysis of 111 898 patients finding statistically significant reductions in intra-operative blood loss ( p = 0.016) and the rate of post-tonsillectomy haemorrhage ( p < 0.0001). 105 Other delivery systems, such as topical and nebulised tranexamic acid may have a role in the initial presentation of posttonsillectomy haemorrhage, but studies thus far have been limited to a small number of case reports and retrospective series. 106,107 Topical hydrogen peroxide has in the past been favoured as an adjunct in acute bleeding and as a peri-operative antimicrobial to reduce the risk of secondary haemorrhage.…”