Growing Use of Tranexamic Acid in Otolaryngology

Experience in the Field

Several otolaryngologists who routinely use TXA provided their perspective on the sorts of procedures in which they use it, how they administer it, and their overall sense of the utility of TXA within otolaryngology in both the adult and pediatric settings.

Habib G. Zalzal, MD, a pediatric otolaryngologist at Children’s National Hospital in Washington, D.C., said that the best use of TXA is for post-tonsillectomy bleeding that occurs one to 14 days after a tonsillectomy. “Emergency department (ED) doctors play a pivotal role in using [TXA] because they are the first to see a lot of these post-tonsillectomy bleeding occurrences,” he said. “When TXA was being used intravenously in kids for active tonsil bleeding, it was working to reduce bleeding because of the clot-stabilizing effect of TXA, and then some EDs started using it topically.”

Dr. Zalzal said this well-documented experience of using TXA in the ED setting has significantly helped his and other institutions reduce the need for visits back to the operating room for bleeding. “When a child presents to the ED with an active bleed in their mouth, historically the child is most likely to be taken to the operating room,” he said. “Within the last couple of years, our ED started using TXA, and the need to take tonsil bleeds back to the operating room has been reduced by greater than 50%.” He said this benefit has helped to avoid further anesthesia and has brought relief to parents who know there is now a medication that can stop the bleeding without a return to the operating room. “When you put TXA in the mouth, it allows the tonsil bed to have a clot-stabilizing effect, so there is no need for an intervention,” he added.

As to complications, he said they include minor nausea, vomiting, abdominal pain, and headaches. He emphasized that there are not enough studies looking into the use of TXA in otolaryngology to know exactly what the complications are from an otolaryngology perspective. “This is a gap in the otolaryngology literature, but in the ED literature it seems to be very safe,” he said. Dr. Zalzal emphasized, however, that TXA should be avoided in children and adults with pro-clotting disorders, as giving TXA in these patients may lead to major complications like strokes.

What hasn’t been studied in the literature is whether TXA prospectively reduces the need to take children back to the operating room after tonsillectomy. “There is a need for guidelines on how to use this within otolaryngology,” he said, reiterating that “it does seem to be a strong medication to prevent repeat anesthesia procedure.”