Tranexamic Acid Use for Posttonsillectomy Hemorrhage Across US Children’s Hospitals

OBJECTIVES: To determine trends and variation in tranexamic acid (TXA) use and to determine whether treatment with TXA is associated with reoperation or hospital admission for children with posttonsillectomy hemorrhage. METHODS: We conducted a retrospective, cross-sectional study of children (<18 y old) with an emergency department encounter for posttonsillectomy hemorrhage from January 1, 2016, to December 31, 2024, using Pediatric Health Information System data. The primary outcome was treatment with TXA. Secondary outcomes included reoperation, hospital admission, and patient factors. We calculated annual hospital-level median percentages and used the Cochran-Armitage test to assess for trends in TXA use when ranked by quartile. We assessed the encounter-level association between secondary outcomes and TXA administration. RESULTS: A total of 19,572 encounters were included. The median age was 7 years (IQR: 4 to 11 y). TXA was used in 1892 (9.7%) encounters. TXA use ranged from 1.0% to 67.1% across hospitals. Median annual TXA use increased from 0.0% in 2016 to 30.6% in 2024. At the hospital level, we observed no difference in reoperation (P=0.941) or hospital admission (P=0.060) by hospital quartile of TXA use. At the encounter level, treatment with TXA was associated with lower adjusted odds of reoperation (aOR: 0.66, 95% CI: 0.56-0.77) but not hospital admission (aOR: 0.93, 95% CI: 0.83-1.04). CONCLUSIONS: We observed a significant increase in TXA use for posttonsillectomy hemorrhage, with substantial hospital-level variation. TXA use was associated with lower odds of reoperation but not hospital admission.