School of Medicine, West Virginia University, Morgantown, WV, United States of America.
Department of Otolaryngology, West Virginia University, Morgantown, WV, United States of America.
Am J Otolaryngol. 2022 Sep-Oct;43(5):103582. doi: 10.1016/j.amjoto.2022.103582. Epub 2022 Aug 6.
To determine if tranexamic acid (TXA) reduces the need for operative re-cauterization in the setting of a post-tonsillectomy hemorrhage (PTH).
A retrospective chart review was performed on 1428 adult and pediatric patients who underwent tonsillectomy over a two-year period at a tertiary care hospital with continuous otolaryngologic coverage. Collected data of PTH patients included age, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, length of stay (LOS), the requirement of a blood transfusion, day of PTH, TXA usage and route, complications from TXA administration, and TXA failure requiring operative intervention.
The incidence of pediatric PTH during the study period was 5.7 %. Twenty-seven out of fifty-five PTH patients received topical, nebulized, or intravenous TXA. No adverse effects were noted with TXA administration. TXA usage provided resolution of the PTH in 77.8 % of patients. No significant differences were found in age, gender, BMI, LOS, ASA classification, rate of blood transfusion, or TXA treatment modality between the patients that received TXA and those that did not.
Treatment of PTH with TXA appears to reduce the need for operative control of PTH. In the setting of reducing operative risk, improving health care utilization, or in a setting without immediate otolaryngologic provider coverage, the role of TXA is promising. Further larger clinical or multi-institution studies are needed to determine the efficacy of TXA, its route of administration, and its optimal dosage.
Level 4, Retrospective cohort study.
确定氨甲环酸（TXA）是否减少扁桃体切除术后出血（PTH）患者需要再次手术烧灼的需求。
对一家三级保健医院在两年间进行扁桃体切除术的 1428 名成人和儿科患者进行回顾性图表审查，该医院有连续的耳鼻喉科覆盖。收集的 PTH 患者数据包括年龄、体重指数（BMI）、美国麻醉医师协会（ASA）分级、住院时间（LOS）、输血需求、PTH 发生日、TXA 使用及其途径、TXA 给药的并发症以及需要手术干预的 TXA 失败。
研究期间儿科 PTH 的发生率为 5.7%。55 例 PTH 患者中有 27 例接受了局部、雾化或静脉 TXA。TXA 给药无不良反应。TXA 使用率使 77.8%的患者 PTH 得到缓解。接受 TXA 和未接受 TXA 的患者在年龄、性别、BMI、LOS、ASA 分级、输血率或 TXA 治疗方式方面无显著差异。
用 TXA 治疗 PTH 似乎减少了 PTH 手术控制的需要。在降低手术风险、改善医疗保健利用率或在没有即时耳鼻喉科提供者覆盖的情况下，TXA 的作用很有前景。需要进一步开展更大规模的临床或多机构研究，以确定 TXA 的疗效、给药途径及其最佳剂量。
4 级，回顾性队列研究。
