Alghamdi Abdullah S, Hazzazi Ghaydaa S, Shaheen Mohammad H, Bosaeed Khlood M, Kutubkhana Rahmah H, Alharbi Ruba A, Abu-Zaid Ahmed, Felemban Roaa A
Department of Otorhinolaryngology, Head and Neck Surgery, Al-Hada Armed Forces Hospital, Taif, Saudi Arabia.
Department of Otorhinolaryngology, Head and Neck Surgery, Hera General Hospital, Makkah, Saudi Arabia.
Eur Arch Otorhinolaryngol. 2025 Mar;282(3):1135-1146. doi: 10.1007/s00405-024-08995-1. Epub 2024 Oct 2.
Post-tonsillectomy bleeding (PTB) is a significant complication and common reason for emergency department (ED) visits. Limited literature has investigated the clinical efficacy of nebulized tranexamic acid (TXA) for treating PTB; however, the results were conflicting and not comprehensively summarized. This study aimed to provide the first-ever systematic review encompassing all literature exploring the efficacy and safety of nebulized TXA in treating PTB.
We screened six databases until 01-July-2024, for relevant studies and assessed their quality using validated tools. We provided a qualitative summary of baseline characteristics and clinical data. The primary endpoint was the reoperation rate to manage PTB, and its effect size was aggregated as a proportion or risk ratio (RR) with a 95% confidence interval (CI) using a random-effects model.
We analyzed nine studies (2 case reports, 4 case series, and 3 retrospective comparative studies), all of which demonstrated good quality and low risk-of-bias. In studies using nebulized TXA for treating PTB (n = 9 studies), the pooled proportion of reoperation to control bleeding was 0.27 (95% CI: 0.08-0.5). The rate of reoperation to control bleeding was significantly lower in the nebulized TXA arm compared to the no-TXA arm (n = 3 studies, RR = 0.55, 95% CI [0.39-0.77], p < 0.001).
Nebulized TXA is safe and promising for treating PTB. This is evidenced by its high efficacy in achieving hemostasis in acute settings during ED visits and reducing the rate of reoperations needed to control PTB. Further high-quality investigations are warranted to corroborate these findings.
扁桃体切除术后出血（PTB）是一种严重并发症，也是急诊科就诊的常见原因。关于雾化氨甲环酸（TXA）治疗PTB的临床疗效的文献有限；然而，结果相互矛盾且未得到全面总结。本研究旨在首次对所有探讨雾化TXA治疗PTB的疗效和安全性的文献进行系统综述。
我们检索了六个数据库至2024年7月1日，查找相关研究，并使用经过验证的工具评估其质量。我们对基线特征和临床数据进行了定性总结。主要终点是处理PTB的再次手术率，其效应量使用随机效应模型汇总为比例或风险比（RR），并伴有95%置信区间（CI）。
我们分析了九项研究（2例病例报告、4例病例系列和3项回顾性对照研究），所有研究均显示质量良好且偏倚风险低。在使用雾化TXA治疗PTB的研究中（n = 9项研究），控制出血的再次手术合并比例为0.27（95% CI：0.08 - 0.5）。与未使用TXA组相比，雾化TXA组控制出血的再次手术率显著更低（n = 3项研究，RR = 0.55，95% CI [0.39 - 0.77]，p < 0.001）。
雾化TXA治疗PTB安全且前景良好。这在急诊科就诊的急性情况下实现止血以及降低控制PTB所需的再次手术率方面的高效性得到了证明。需要进一步的高质量研究来证实这些发现。
