The therapeutic use of tranexamic acid reduces reintervention in paediatric secondary post-tonsillectomy bleeding
Alessandra Locatelli Smith, Hannah Louisa Cornwall, Emily Zhen, Anton Hinton‐Bayre, Hayley Herbert, Shyan Vijayasekaran
Abstract
Background: Secondary haemorrhage is an uncommon but potentially fatal complication affecting 0.2–7.5% of patients after tonsillectomy. Tranexamic acid (TXA) is widely used to reduce intraoperative and traumatic blood loss in both paediatric and adult populations, however there are sparse data assessing the use of TXA in the acute management of paediatric secondary post-tonsillectomy bleeding (PTB). Methods: Retrospective case-control study using records generated contemporaneously to assess the effect of TXA on reintervention rates in theatre and need for blood transfusion in children presenting with a secondary PTB. Within 24 h remaining stable, patients were discharged with 5 days on oral TXA; 165 patients received TXA; 65 patients did not. Results: Twenty-six (13%) patients in the TXA group and 15 (23%) patients in the control group returned to theatre for management of PTB. Difference between groups (P=0.042) with OR 0.51 (95% CI, 0.252–0.983). No difference was observed in the incidence of blood transfusion, however the study was underpowered with regards to this outcome. Surgical expertise and surgical technique did not seem to affect the rate of return to theatre in this population. Conclusions: Intravenous TXA may be of benefit in the acute management of paediatric secondary PTB, reducing readmission to theatres for surgical reintervention. Large multi-centre randomised controlled trials are required to convincingly demonstrate causation and to evaluate the effect of TXA on rates of blood transfusion).