The Efficacy of Tranexamic Acid in Pediatric Tonsillectomy: A Systematic Review and Meta-Analysis

Complications of tonsillectomy, such as intraoperative and post-tonsillectomy hemorrhage (PTH), are not uncommon. In children, these may lead to hypovolemic shock, airway obstruction, delayed healing, and infection, among other issues. Tranexamic acid (TXA) is one of several hemostatic agents. However, its efficacy in reducing bleeding during tonsillectomy is not well known. Hence, we aimed to determine whether children undergoing tonsillectomy experienced less perioperative hemorrhage after receiving a preoperative dose of TXA. Two reviewers independently conducted a systematic search of three databases (PubMed, Google Scholar, and the Cochrane Central Register of Controlled Trials [CENTRAL]) until June 2024. This review included all randomized controlled trials (RCTs) involving pediatric patients (<18 years) undergoing tonsillectomy, focusing on studies that evaluated the efficacy of preoperative TXA compared with a control group in reducing intraoperative or postoperative bleeding. The studies varied in outcomes, designs, and sample sizes. A meta-analysis of four studies (n = 380) revealed no significant effect of TXA in reducing intraoperative bleeding (weighted mean difference = -54.44 (95% confidence interval [CI] = -110.98 to -2.10, p= 0.06). Preoperative TXA did not significantly reduce intraoperative bleeding. Future RCTs should assess surgical techniques, TXA dosage, bleeding measurement, patient age, and postoperative medications.