pem pearl: txa in post-tonsillectomy hemorrhage
Post-tonsillectomy hemorrhage is a rare albeit very serious complication from a relatively common procedure. We have had a few cases of this recently in the PED and the initial presentation can be visually alarming (blood pouring from the mouth, yikes) and the patients can get very sick, very quick. More common treatment modalities include cold-water gargle (hard to do with, as noted, blood pouring from your mouth), nebulized racemic epi, direct pressure (prob not) and topic treatments with epi and cautery.
Nebulized tranexamic acid (TXA) is an up-and-coming treatment that has a good track record in terms of efficacy and safety, although no large, prospective studies have been done. These are 2 retrospective studies that do show very good results in nebulizing TXA for post-tonsillectomy hemorrhage.
Bottom line: Nebulized TXA (500mg-1g) for post-tonsillectomy hemorrhage can help prevent need for operative intervention and can decrease rates of rebleeding.
Lastly, if you want to get into the research weeds, the larger study by Shin demonstrates a well done retrospective study (larger with case matched controls), while the more recent, smaller study by Maksimoski does not discuss their methodology or compare patients (did the TXA patients have more severe or more mild bleeding, etc) and therefore overall is a less impactful study. Worth reading to compare if you're interested!
Nebulized tranexamic acid (TXA) is an up-and-coming treatment that has a good track record in terms of efficacy and safety, although no large, prospective studies have been done. These are 2 retrospective studies that do show very good results in nebulizing TXA for post-tonsillectomy hemorrhage.
Bottom line: Nebulized TXA (500mg-1g) for post-tonsillectomy hemorrhage can help prevent need for operative intervention and can decrease rates of rebleeding.
Lastly, if you want to get into the research weeds, the larger study by Shin demonstrates a well done retrospective study (larger with case matched controls), while the more recent, smaller study by Maksimoski does not discuss their methodology or compare patients (did the TXA patients have more severe or more mild bleeding, etc) and therefore overall is a less impactful study. Worth reading to compare if you're interested!
