Assessment of the effect of tranexamic acid on perioperative bleeding in pediatric patients undergoing tonsillectomy

Abstract

Background: Tonsillectomy is one of the most common surgery in pediatric and bleeding is one of the most serious complications related to tonsillectomy. Tranexamic acid is a plasminogen inhibitor which has been successfully used to control bleeding in a variety of surgeries. Aim: The aim of the present study was to assess the effect of tranexamic acid on bleeding in pediatric patients undergoing elective tonsillectomy. Materials and methods: The present study included 225 patients classified into three groups: (n = 75): Group A: The tranexamic acid was given after induction intravenously as 15 mg/kg over 10 min. Group B: The tranexamic acid was given after induction intravenously as 15 mg/kg over 10 min and continued infusion as 5 mg/kg/h during surgery. Group C (control group): The patients did not receive tranexamic acid. The bleeding was assessed by the extent of blood loss using the Boezaart blood grading scale, measuring blood in the suction jar, and by visual estimation of 4 · 4 gauze pads. Results: The comparison of Boezaart blood grading scale and amount of blood loss was insignificant between the three groups (p > 0.05). Conclusion: The present study showed no effect of tranexamic acid in decreasing the tonsillectomyrelated bleeding and there is no complication related to tranexamic acid. We are recommending other studies to measure the fibrinolytic activity during tonsillectomy and its inhibition by tranexamic acid.

Efficacy and Safety of Antifibrinolytic Drugs in Pediatric Surgery: A Systematic Review

“…The initial search for studies that compared antifibrinolytic drugs to placebo in pediatric surgery retrieved 5,021 hits from which 306 articles were fully screened. In total, 50 randomized placebo-controlled trials were included in this systematic review, among which 15 studies rated good, [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] 19 fair, [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61] and 16 poor. [62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77] Detailed rating informati...…”

“…28,30-36,38-40,45,47 51,53,54,58,59 Transfusion requirements were reported by 14 studies, 30,31,[33][34][35][36]38,40,45,47,51,53,54,59 reoperation was reported by three studies, 34,50,51 and two studies reported rebleeding. 58,60 The size of the study populations ranged from 26 to 225 patients.…”

“…Four studies investigated TXA in surgeries within the ear, nose, and throat specialty. 28,32,50,58 Two studies reported their operation time ranging from 38 AE 7 to 65 AE 13 minutes. 32,58 Dosing Regimen Dosing regimens are illustrated in ►Fig.…”

“…Soliman et al additionally used a continuous infusion of 5 mg/kg. 58 Brum et al used the highest cumulative dose (mean: 1.13 mg/kg, SD: 0.79-1.98) 28 and Eldaba et al used the lowest (mean: 0.34 mg/kg, SD: 0.5-1.18). 32…”

Sangrado intraoperatorio de amigdalectomía en población pediátrica. Influencia de factores quirúrgicos y anestésicos

“…Se han descrito múltiples factores asociados al sangrado intraoperatorio, tales como: tipo de patología amigdalina subyacente (presencia de fibrosis, amigdalitis crónica) [9], la técnica quirúrgica (técnica caliente o fría) [12], uso de AINEs como el ketorolaco [13], presencia de coagulopatías previas [14], uso de antifibrinolíticos como el ácido tranexámico [15], [16], procoagulantes como el subgalato [17] y el uso de antibióticos [9]. Estos factores son controvertidos y han sido puestos en duda por algunos autores.…”