Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Chicago, IL, USA.
Department of Emergency Medicine, Northwestern University, Chicago, IL, USA.
Ann Otol Rhinol Laryngol. 2024 Aug;133(8):729-734. doi: 10.1177/00034894241254697. Epub 2024 May 27.
The use of nebulized tranexamic acid (TXA) in massive pulmonary hemorrhage is well-described. Published utilization in post-tonsillectomy bleeding (PTB) is limited to a single case. This study examines whether TXA resulted in change of operative intervention necessity and narcotic utilization.
This was a retrospective cohort study at a single, urban academic medical center in the United States. Chart review was conducted of all patients who presented to the hospital for post-tonsillectomy bleed (PTB) between 3/1/2018 and 7/1/2020. Demographic data, intervention modality, need for control under general anesthesia, and opioid use were collected and analyzed.
Twenty-one patients underwent a total of 23 visits for PTB over the study period. Control of hemorrhage without need for operating room intervention for PTB was 100% (6/6) for patients receiving TXA nebulizer and 53% (9/17) for those receiving other treatment modalities. Opioid usage in hospital and on discharge was also lower in patients receiving TXA nebulizers. All results were statistically significant.
Our study supports nebulized TXA as an effective, non-invasive mode of hemostasis in patients presenting to the emergency department for post-tonsillectomy hemorrhage. Nebulized TXA may prevent the need for general anesthesia and operative intervention. Otolaryngologists should consider addition of this novel treatment appropriation of TXA to their management options for postoperative tonsillar hemorrhage.
雾化氨甲环酸（TXA）在大量肺出血中的应用已有详细描述。在扁桃体切除术后出血（PTB）中的应用仅限于单个病例。本研究旨在探讨 TXA 是否会改变手术干预的必要性和麻醉药物的使用。
这是在美国一家单一的城市学术医疗中心进行的回顾性队列研究。对 2018 年 3 月 1 日至 2020 年 7 月 1 日期间因扁桃体切除术后出血（PTB）到医院就诊的所有患者进行了图表回顾。收集并分析了人口统计学数据、干预方式、全麻下控制出血的必要性和阿片类药物的使用情况。
在研究期间，21 名患者共进行了 23 次 PTB 就诊。接受 TXA 雾化器治疗的患者中，PTB 无需手术干预控制出血的比例为 100%（6/6），而接受其他治疗方式的患者为 53%（9/17）。接受 TXA 雾化器治疗的患者在医院和出院时的阿片类药物使用量也较低。所有结果均具有统计学意义。
本研究支持将雾化 TXA 作为一种有效、非侵入性的止血方式，用于因扁桃体切除术后出血而就诊于急诊科的患者。雾化 TXA 可能预防全麻和手术干预的需要。耳鼻喉科医生应考虑将这种新型 TXA 治疗方法添加到其术后扁桃体出血的治疗方案中。
