The Effectiveness of Tranexamic Acid in Pediatric Posttonsillectomy Hemorrhage (A Systematic Review and Meta-Analysis).

Abstract

To systematically review the literature regarding the effectiveness of tranexamic acid (TXA) in the management of pediatric post-tonsillectomy hemorrhage (PTH). Comprehensive searches across PubMed, Embase, and Web of Science were conducted through December 2024 in accordance with Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines. Studies evaluating TXA (any route) for PTH in children aged 2 to 18 years were reviewed. Study characteristics, patient demographics, tonsillectomy technique, postoperative day on presentation, patient exam, route of TXA administration, and dosage were extracted. The primary outcome of interest was the rate of reoperation for hemostasis; secondary outcomes of interest included need for blood transfusion and adverse effects. Eight studies (n = 801) met inclusion criteria. TXA administration was associated with a significant reduction in reoperation rates for hemostasis (pooled RR = 0.62, 95% CI 0.49-0.78), with no significant difference between routes of administration. There was no statistically significant difference in transfusion risk (RR = 0.76, 95% CI 0.26-9.45). Across all studies, no adverse effects attributable to TXA were reported. TXA use in managing pediatric PTH is associated with a significant reduction in reoperation rates, with both intravenous and nebulized formulations demonstrating similar effectiveness. Nebulized TXA offers practical advantages in pediatric patients and provides potential targeted oropharyngeal delivery. The available evidence is limited by retrospective study designs, small sample sizes, and risk of bias. These findings support the need for prospective studies to standardize assessment and treatment algorithms, optimize management, inform clinical practice guidelines.