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Scientific Oral Presentations

Pediatric Otolaryngology

Session: Scientific Oral Presentations 1 - Pediatric Otolaryngology

Nebulized Tranexamic Acid for the Control of Pediatric Posttonsillectomy Hemorrhage

Saturday, September 28, 2024
9:42 AM – 9:48 AM EDT
Location: MBCC, 225
Disclosure(s):
Elie Khalifee, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Adrian Williamson, MD, IV:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Macaulay A. Ojeaga, MD, Jr.:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Antonio A. Bon Nieves, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Jill M. Arganbright, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Recent studies have shown that off-label use of tranexamic acid (TXA) may be a safe and effective modality to control post-tonsillectomy hemorrhage. Given the scarcity of reports on this topic, the aim of this study is to determine whether nebulized TXA is safe and effective in controlling PTH and decreasing the need for surgical hemostatic control.

Methods: A retrospective chart review of all patients presenting to a pediatric tertiary medical center with post tonsillectomy hemorrhage from January 2019 until September 2023 were included. Inclusion criteria included age less than 18 years. Demographic data included age and gender. Clinical data included BMI percentile, trainee presence and indication for tonsillectomy, pharyngeal exam at presentation, blood work-up, treatment modalities employed including observation, nebulized TXA use and surgical control of bleed, as well as length of hospital stay and readmission after control of bleed and discharge.

Results: A total of 286 patients, divided into 162 males and 124 females, were included. The mean age was 7.822 + 4.396 years. Pharyngeal exam on presentation revealed a clot in 173 patients, active oozing in 43 and a suspicious raw surface in 24 patients. Patients presented on mean postop day 5.471 + 3.105. The nebulized TXA group included 99 patients and the group not receiving neb TXA included 187 patients.

The pharyngeal exam on admission was within normal limits in 14.1% of patients who received neb TXA vs 35.8% of patients who did not receive neb TXA (p-value < 0.05). A significantly lower percentage of patients required surgical control of bleeding in the nebulized TXA group compared to the group that did not receive neb TXA (28.3% vs 41.7%, p-value < 0.05). The rate of readmission was low in both groups and difference did not reach statistical significance (neb TXA 7.1% vs other group 7.5%, p-value > 0.05). No complications were noted due to neb TXA administration.

Conclusions: Nebulized TXA seems to be a safe and effective modality for the management of post-tonsillectomy hemorrhage. Future prospective studies are needed to better evaluate the efficacy of neb TXA.

    Presenting Author(s)

  • Macaulay A. Ojeaga, Jr., MD

    Resident PGY-4
    Childrens Mercy Hospital Kansas City, University of Kansas Medical Center
    Kansas City , MO, United States

    Disclosure information not submitted.

    • Co-Author(s)

  • Elie Khalifee, MD

    Assistant Professor
    Children's Mercy Hospital Kansas City
    Kansas City, MO, United States

    Disclosure information not submitted.

  • Adrian Williamson, IV, MD

    Assistant Professor
    Arkansas Children’s Hospital
    Little Rock, AR, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • AN

    Andrea T. Nguyen, BS

    Medical Student
    Kansas City University College of Osteopathic Medicine, Kansas City, MO, USA
    Wichita, KS, United States

    Disclosure information not submitted.

  • Antonio A. Bon Nieves, BS

    Clinical Research Fellow
    University of Kansas Medical Center
    San Juan, PR, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Jill M. Arganbright, MD

    Pediatric Otolaryngology
    Childrens Mercy Hospital Kansas City
    Kansas City, MO, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Senior Author(s)

  • Elie Khalifee, MD

    Assistant Professor
    Children's Mercy Hospital Kansas City
    Kansas City, MO, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.