(A228) Nebulized Tranexamic Acid Reduces the Need for Operative Cautery for Acute Secondary Post-tonsillectomy Hemorrhage

Introduction: Tranexamic acid (TXA) has recently gained attention for its potential to stabilize bleeding in patients who present emergently with post-tonsillectomy hemorrhage. The purpose of this study was to determine the efficacy of nebulized TXA for secondary post-tonsillectomy hemorrhage.

Methods: This was a retrospective study of adult and pediatric patients who presented to our tertiary care center for post-tonsillectomy hemorrhage, >24 hours following tonsillectomy, between January 2014 and December 2024. Patients who were not actively bleeding on presentation were excluded from the study. Outcomes were compared between patients who received nebulized TXA and those who did not. Outcomes measured in this study included need for operative intervention, length of hospital stay, and readmission rate. Data analysis is ongoing.

Results: There were 84 encounters included with active bleeding on presentation, and 51 received nebulized TXA. Patients who received nebulized TXA were significantly less likely to require operative intervention (OR = 0.328 [0.121-0.891]). If operative intervention was required following administration of nebulized TXA (54.90%), the time from presentation to operative intervention was significantly longer in those who received nebulized TXA (319.33 ± 301.27 minutes vs 187.59 ± 232.93 minutes, p = 0.036). Nebulized TXA was not associated with a longer hospital length of stay (1.18 ± 1.12 days vs 1.46 ± 1.37 days, p = 0.160). Nebulized TXA was not associated with a higher readmission rate for recurrent bleeding (8.0% vs 15.15%, p = 0.472). No adverse effects of nebulized TXA were identified.

Conclusions: Administration of nebulized TXA is a safe and effective strategy for acute stabilization of post-tonsillectomy hemorrhage. Nebulized TXA reduced the rate of operative intervention for post-tonsillectomy hemorrhage and stabilized the acute hemorrhage such that operative intervention could safely be delayed in those who still required operative cautery. Readmission rates were similar between groups and nebulized TXA was not associated with an increased duration of inpatient monitoring.