Volume 12, Issue 3 (2023)                   WJPS 2023, 12(3): 31-36 | Back to browse issues page

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Abtahi M, Kargoshai A, Shetabi H, Manafi A, Manafi N, Badrouj A. The Effect of Tranexamic Acid Local Injection on Bleeding during and after Tonsillectomy: A Double-Blind Randomized Placebo-Controlled Trial. WJPS 2023; 12 (3) :31-36
URL: http://wjps.ir/article-1-1184-en.html
1- Department of Otorhinolaryngology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
2- Department of Otorhinolaryngology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
3- Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
4- Department of Anesthesia, Detroit Medical Center, NorthStar Anesthesia, Detroit, MI.
Abstract:   (882 Views)
Background: Tonsillectomy-related bleeding is one of the most prevalent and potentially fatal complications of this common surgical procedure. We aimed to assess the effect of tranexamic acid (TXA) local injection on bleeding during and after tonsillectomy.
Methods: This double-blind, randomized placebo-controlled trial included 20 candidates for tonsillectomy referred to Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran, in 2022. The subjects were randomized into two groups. Ten patients received TXA on their left side and the other ten on their right side 10 min before surgery. Placebo was administered to the contralateral side. The primary outcome was the volume of blood loss during tonsillectomy and up to 24 hours post-tonsillectomy. The secondary outcomes were surgeon satisfaction (rated 0-10), hemodynamic complications (patients’ heart rate (HR) and mean arterial pressure (MAP) were recorded every 10 min), and rebleeding. The duration of surgery was also noted.
Results: The mean age of the patients was 21.35 ± 3.16 years, of whom 8 (30%) were male and 12 (60%) were female. there was no significant difference between groups in terms of HR and MAP at any time point. The median of surgery duration did not differ significantly between the two groups; however, the surgeon satisfaction with the procedure was significantly higher with TXA compared to placebo. None of the patients developed hemodynamic complications, and rebleeding did not occur in any of the subjects.
Conclusions: TXA local injection was not superior to placebo in terms of bleeding control during and after tonsillectomy, hemodynamic complications, rebleeding, and surgery duration.
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Type of Study: Original Article | Subject: Special
ePublished: 2023/12/30

1. Bohr C, Shermetaro C. Tonsillectomy and Adenoidectomy. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2022, StatPearls Publishing LLC.; 2022.
2. Dhaduk N, Rodgers A, Govindan A, Kalyoussef E. Post-Tonsillectomy Bleeding: A National Perspective. Ann Otol Rhinol Laryngol 2021 Aug;130(8):941-7. [DOI:10.1177/0003489420987438]
3. Hsueh WY, Hsu WC, Ko JY, Yeh TH, Lee CH, Kang KT. Postoperative hemorrhage following tonsillectomy in adults: Analysis of population-based inpatient cohort in Taiwan. Auris Nasus Larynx 2019 Jun;46(3):397-406. [DOI:10.1016/j.anl.2018.10.008]
4. Mitchell RB, Archer SM, Ishman SL, et al. Clinical Practice Guideline: Tonsillectomy in Children (Update)-Executive Summary. Otolaryngol Head Neck Surg 2019 Feb;160(2):187-205. [DOI:10.1177/0194599818807917]
5. Clark CM, Schubart JR, Carr MM. Trends in the management of secondary post-tonsillectomy hemorrhage in children. Int J Pediatr Otorhinolaryngol 2018 May;108:196-201. [DOI:10.1016/j.ijporl.2018.03.004]
6. Kuo CC, DeGiovanni JC, Carr MM. The efficacy of Tranexamic Acid Administration in Patients Undergoing Tonsillectomy: An Updated Meta-Analysis. Ann Otol Rhinol Laryngol 2022;131(8):834-43. [DOI:10.1177/00034894211045264]
7. Reed MR, Woolley LT. Uses of tranexamic acid. Continuing Education in Anaesthesia, Critical Care and Pain 2015;15(1):32-7. [DOI:10.1093/bjaceaccp/mku009]
8. McCormack PL. Tranexamic acid: a review of its use in the treatment of hyperfibrinolysis. Drugs 2012 Mar 26;72(5):585-617. [DOI:10.2165/11209070-000000000-00000]
9. Robb PJ. Tranexamic acid - a useful drug in ENT surgery? J Laryngol Otol 2014 Jul;128(7):574-9. [DOI:10.1017/S0022215114001285]
10. Erwin DZ, Heichel PD, Wright LB, et al. Post-tonsillectomy hemorrhage control with nebulized tranexamic acid: A retrospective cohort study. Int J Pediatr Otorhinolaryngol 2021 Aug;147:110802. [DOI:10.1016/j.ijporl.2021.110802]
11. Hinder D, Tschopp K. [Topical application of tranexamic acid to prevent post-tonsillectomy haemorrhage]. Laryngorhinootologie 2015 Feb;94(2):86-90.
12. Schroeder RJ, 2nd, Langsdon PR. Effect of Local Tranexamic Acid on Hemostasis in Rhytidectomy. Facial Plast Surg Aesthet Med 2020 May/Jun;22(3):195-9. [DOI:10.1089/fpsam.2020.0061]
13. Zilinsky I, Barazani TB, Visentin D, Ahuja K, Martinowitz U, Haik J. Subcutaneous Injection of Tranexamic Acid to Reduce Bleeding During Dermatologic Surgery: A Double-Blind, Placebo-Controlled, Randomized Clinical Trial. Dermatol Surg 2019 Jun;45(6):759-67. [DOI:10.1097/DSS.0000000000001786]
14. Gausden EB, Qudsi R, Boone MD, O'Gara B, Ruzbarsky J, Lorich DG. Tranexamic acid in orthopaedic trauma surgery: a meta-analysis. J Orthop Trauma 2017;31(10):513. [DOI:10.1097/BOT.0000000000000913]
15. Spencer R, Newby M, Hickman W, Williams N, Kellermeyer B. Efficacy of tranexamic acid (TXA) for post-tonsillectomy hemorrhage. Am J Otolaryngol 2022;43(5):103582. [DOI:10.1016/j.amjoto.2022.103582]
16. Ashraf MA, Ahmed I, Bhatti S, Rai D, Qureshi SS, Tasleem RF. Compare Mean Blood Loss in Patients Undergoing Tonsillectomy with and without Tranexamic Acid. Pak J Med Health Sci 2022;16(07):799-. [DOI:10.53350/pjmhs22167799]
17. Shafa A, Besharati S, Shetebi H, Shahhoseini S, Zadeh AR. Comparative study of the effect of administering two doses of tranexamic acid in patients undergoing adenotonsillectomy. Int J Physiol Pathophysiol Pharmacol 2022;14(4):233.
18. Fornazieri MA, Kubo HKL, Farias LCd, et al. Effectiveness and Adverse Effects of Tranexamic Acid in Bleeding during Adenotonsillectomy: A Randomized, Controlled, Double-blind Clinical Trial. Int Arch Otorhinolaryngol 2021;25:557-62. [DOI:10.1055/s-0040-1722255]
19. Soliman R, Alshehri A. Assessment of the effect of tranexamic acid on perioperative bleeding in pediatric patients undergoing tonsillectomy. Egyptian Journal of Anaesthesia 2015;31(4):297-301. [DOI:10.1016/j.egja.2015.07.002]
20. Brum MR, Miura MS, de Castro SF, Machado GM, Lima LH, Neto JFL. Tranexamic acid in adenotonsillectomy in children: a double-blind randomized clinical trial. Int J Pediatr Otorhinolaryngol 2012;76(10):1401-5. [DOI:10.1016/j.ijporl.2012.04.028]
21. Chan CC, Chan YY, Tanweer F. Systematic review and meta-analysis of the use of tranexamic acid in tonsillectomy. Eur Arch Otorhinolaryngol 2013;270(2):735-48. [DOI:10.1007/s00405-012-2184-3]
22. Santosh UP, Prashanth KB, Abhilash S. A comparative study to verify the efficacy of preoperative intravenous tranexamic acid in control of tonsillectomy bleeding. Otorhinolaryngol Clin 2016;8(1):22-5. [DOI:10.5005/jp-journals-10003-1219]
23. Franchini M, Mengoli C, Marietta M, et al. Safety of intravenous tranexamic acid in patients undergoing majororthopaedic surgery: a meta-analysis of randomised controlled trials. Blood Transfusion 2018;16(1):36.
24. Shakur H, Beaumont D, Pavord S, Gayet‐Ageron A, Ker K, Mousa HA. Antifibrinolytic drugs for treating primary postpartum haemorrhage. Cochrane Database of Systematic Reviews 2018(2). [DOI:10.1002/14651858.CD012964]

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