Author(s)
Diego A. Preciado, MD, PhD
Katerina Faben
Samantha B. Allen, MD
Habib G. Zalzal, MD
Hengameh K. Behzadpour, MSHS
Alexandra G. Espinel, MD
Affiliation(s)
Otolaryngology, Children's National Hospital, Washington DC, USA
Abstract:
Introduction: Tonsillectomies are among the most commonly performed pediatric procedures. Nebulized tranexamic acid (TXA) is rapidly evolving for routine use for treatment and management of post-tonsillectomy hemorrhage (PTH). Depending on severity and clinical presentation, TXA can serve as successful intervention and alleviate the need for the operating room (OR). We sought to examine the benefit of this recently available intervention at our tertiary care pediatric institution.
Methods: Retrospective chart review of rate of return to operating room in patients with PTH with active bleed or clot who did or did not receive TXA from April 2024- August 2025, pre and post TXA protocol implementation at our institution Patient demographics and clinical characteristics collected included bleed post operative day (POD), TXA received, and management (observation success versus failure and need for OR). Patients who went straight to the OR were excluded due to need for immediate surgical management.
Results: Of 4108 tonsillectomies in the study periods, 85 (2.07%) presented to our emergency room with bleeding, 26 were bleeds from outside hospitals. The mean postop day of bleed was 5. Of the 65 patients included in the study, 29 did not have bleed or clot at arrival. For the remaining patients those who received TXA (6.38%) were significantly less likely to need the OR compared to those who didn’t receive TXA (6.38% vs, 27.8%, p=0.0318). Patients receiving TXA had a shorter time to OR than those not receiving TXA (205 minutes versus 292 minutes, p=0.6757). and mean time to discharge was almost 2-fold higher in patients who did not receive TXA (1137 minutes vs 655 minutes p=0.0012).
Discussion: Since the implementation of a TXA protocol, the need for OR intervention in children being observed with PTH has significantly decreased. Moreover, the overall length of stay for patients receiving TXA has also significantly been shortened. Further investigation is needed into the impact of TXA as a treatment option for post-tonsillectomy hemorrhage.