Growing Use of Tranexamic Acid in Otolaryngology

Dr. Zalzal emphasized the need for more clinical trials on the use of TXA in otolaryngology and hopes that by 2026, more formal research and guidelines will be developed. Currently, he and his colleagues at Children’s National Hospital are finalizing a study on the use of TXA in pediatric patients for post-tonsillectomy bleeding and are working to bring other institutions on board for a larger, prospective randomized clinical trial.

Even without large-scale studies, he underscored that the safety profile and promising results from off-label and anecdotal use of TXA support its use in emergency situations. “Consider checking with the emergency department [to which] you refer your post-operative patients to see if they are using TXA, and how they are using it, and whether or not there is a role for using nebulized or at least topical TXA,” he said.

John Carter, MD, a pediatric otolaryngologist and system chair for the department of otolaryngology at Ochsner Health in Covington, La., said that his institution has a protocol to manage post-operative tonsillectomy hemorrhage. “We give nebulized TXA, and we found that it dramatically reduces the number of children who have to return to the operating room to control the bleed,” he said. “That is the biggest use of it in pediatric otolaryngology.”

Dr. Marino said in his practice, he uses TXA for two primary reasons. One, to stop nosebleeds, using TXA as a topical spray in the nose, and the second for nasal procedures for sinonasal surgery, in which they give TXA intravenously at a dose of one gram either before or during surgery, which, he said, may help with bleeding during surgery.

Although he said it is difficult to gauge the differences in bleeding control with the use of intravenous TXA for an individual experience, he said its efficacy in this type of situation aligns with what has been published.

He encouraged otolaryngologists to familiarize themselves with TXA, specifically when giving the one gram intra-operatively, to get comfortable with using it, and underscored its very good safety profile except in rare cases. “I think people who have a thrombotic stroke or are undergoing an elective procedure are not good candidates for this,” he said, reiterating that the safety of TXA is very, very good for most patients.

“TXA is a good option; it inhibits plasminogen, which breaks down clots, so TXA is a clot stabilizer that doesn’t promote clot formation, and that may worry people about it,” he said. “All that TXA is doing is stabilizing clots that are forming.