Preoperative Systemic Tranexamic Acid in Tonsillectomy and Adeno-tonsillectomy: A Relevant Underrated Outcome
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Abstract
Introduction
Tranexamic acid, a synthetic anti-fibrinolytic plasminogen inhibitor, a relatively safe drug, is reported to reduce bleeding in various surgical procedures. Our study was to identify the efficacy of tranexamic acid in reducing intraoperative bleeding during tonsillectomy and adeno-tonsillectomy, a common paediatric ENT surgery done as day care procedure.
Materials and Methods
A randomised, placebo controlled, double blinded trial was undertaken with consecutive patients undergoing above procedures, sample size being 100, with 50 patients in each arm. Post induction, injection tranexamic acid 15mg /kg body weight and saline was given to the test and control group respectively. Intraoperative bleeding was measured and operating time was also noted.
Results
There were 80 participants, with 41 and 39 patients in treatment and placebo group respectively ranging from 4 to 32 years age. There was no significant difference in the amount of blood loss between the two groups. However, the duration of surgery was significantly lowered in tranexamic acid as compared to placebo group (p = 0.008).
Conclusions
Preoperative use of tranexamic acid in tonsillectomy or adeno-tonsillectomy, significantly reduced operating time though no significant reduction of intra or postoperative bleeding was noted. This previously unreported outcome has surgical implication, especially in children, for possible use of this widely accepted safe drug during these procedures.
Article Details
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References
Prasad KC, Prasad SC. Assessment of Operative blood loss and the factors affecting it in Tonsillectomy and Adenotonsillectomy. Indian Journal of Otolaryngology, Head and Neck Surgery 2011; 63(4):343-8. doi 10.1007/s12070-011-0268-9
Weitz JI. Blood Coagulation and Anticoagulant, Fibrinolytic and Antiplatelet Drugs. In: Laurence LB, Bruce AC, Bjorn CK (eds). Goodman & Gilman’s The Pharmacological basis of Therapeutics. 13th edition. New York: McGraw-Hill Education; 2017.p596.
Soliman R, Ali Alshehri A. Assessment of the effect of tranexamic acid on perioperative bleeding in paediatric patients undergoing tonsillectomy. Egyptian Journal of Anaesthesia 2015; 31:297-301. https://doi.org/10.1016/j.egja.2015.07.002
Brum MR, Miura MS, Castro SF, Machado GM, Lima LH, Lubianca Neto JF. Tranexamic acid in adenotonsillectomy in children: a double-blind randomised clinical trial. Int J Pediatr Otorhinolaryngol. 2012; 76(10):1401-5. doi: 10.1016/j.ijporl.2012.04.028
Chan CC, Chan YY, Tanweer F. Systematic review and meta-analysis of the use of tranexamic acid in tonsillectomy. Eur Arch Otorhinolaryngol. 2013; 270(2):735-48. doi:10.1007/s00405-012-2184-3
George A, Kumar R, Kumar S, Shetty S. A randomised control trial to verify the efficacy of pre-operative intra venous tranexamic acid in the control of tonsillectomy bleeding. Indian Journal of Otolaryngology Head and Neck Surgery 2011; 63(1):20-26.2. doi: 10.1007/s12070-010-0095-4
Alessandra LS, Hannah LC, Emily Z, Anton HB, Hayley H, Shyan V. The therapeutic use of tranexamic acid reduces reintervention in paediatric secondary post-tonsillectomy bleeding. Australian Journal of Otolaryngology doi: 10.21037/ajo.2020.04.02. https://www.researchgate.net/publication/340591997.
Robb PJ, Thorning G. Perioperative tranexamic acid in day-case paediatric tonsillectomy. Annals Royal College of Surgeons England 2014; 96(2):127-9. doi: 10.1308/003588414X13814021676477
Manikandan D, Musarrat F, Preetham AP, Anjali R. Measurement of blood loss during adenotonsillectomy in children and factors affecting it. Case Reports in Clinical medicine 2015; 04(05):151-6. doi: 10.4236/crcm.2015.45032.