Educational Objective: At the conclusion of this presentation, the participants should be able to evaluate indications, dosages, and advantages of tranexamic acid usage in post-tonsillar hemorrhages after adenotonsillectomies.
Objectives: To compare the effectiveness of application of tranexamic acid to the standard of care of operative recauterization for tonsillar hemorrhages and its safety profile. Study Design: Retrospective chart review.
Methods: A retrospective chart review was performed on 1,603 patients who underwent tonsillectomy and/or adenoidectomy over a two year period at a tertiary care hospital with continuous otolaryngologic coverage. Patient data collected included patient age, BMI, ASA number, and past medical history of bleeding disorders. We then separated patients into two cohorts - those that had postoperative tonsillar hemorrhage and those who did not. Of the patients who had postoperative tonsillar hemorrhage, patients were then further divided into groups based on the specific treatment intervention(s). Intervention types included observation only, TXA only, OR only, and combination of these interventions. To evaluate and compare interventions across the intervention groups, postoperative bleeding day, length of hospital stay, and other postoperative complications were studied. Comparisons among these four groups were analyzed with ANOVA testing (p < 0.05 significance).
Results: The average timeframe from surgery to postoperative bleeding was 6.29 days. The average for each group was 7 days, 6 days, 4.95 days, and 5.41 days for the observation only, TXA only, OR only, and multiple intervention groups respectively. Among the patients with postoperative tonsillar hemorrhages, the average length of hospital stay was 0.96 days, 1.2 days, 1 day and 1 day for the observation only, TXA only, OR only, and multiple intervention groups respectively. The f ratio value was 0.13017 with a p value of .941886 (p < 0.05). There were no postoperative complications with the administration of TXA for post-tonsillectomy hemorrhage.
Conclusions: There was no statistically significant difference of length of hospital stay among those with postoperative hemorrhage who were given TXA in comparison to those who were monitored for observation, underwent OR interventions, or patients with multiple intervention group. TXA should be considered as valid therapeutic option for patients that have post-tonsillectomy hemorrhage to reduce patient and parent mental distress, utilization of healthcare resources, and repeated anesthesia exposures within the pediatric population.