(A153) Use of Tranexamic Acid to Reduce the Occurrence of Post-Tonsillectomy Hemorrhage

Introduction: Although tranexamic acid (TXA) is regularly used to manage surgical bleeding, its perioperative use for post-tonsillectomy hemorrhage (PTH) prevention remains less established. This QI study aimed to evaluate the efficacy of a prophylactic TXA dosing regimen combining IV and oral administration in reducing PTH occurrence at a single site in adults.

Methods: This QI study at UConn Health analyzed patients over 18 who underwent tonsillectomy from 2018 through 2024, using data from EPIC slicer-dicer. With the goal of decreasing the rate of PTH, two tonsil surgeons offered patients TXA postoperatively with the intent of using PDSA cycles to adjust the treatment protocol. Patients in the TXA group received a 1 g dose of TXA in 0.9% sodium chloride IV in the PACU following tonsillectomy and completed 1,300 mg of oral TXA three times daily for 5 days, starting on postoperative day 2. Those who were medically excluded from taking TXA, wished not to take TXA, or had an incomplete treatment course were placed in the non-TXA group. The non-TXA control group also consisted of the patients who underwent tonsillectomy prior to the surgeons use of TXA. Demographics, surgical indications, and postoperative outcomes were collected via retrospective chart review. Statistical analyses included Fisher’s exact t-test.

Results: Three hundred thirty (330) tonsillectomy patients were included; 72 qualified for the TXA group and 258 for the non-TXA control group. The control group had 20 hemorrhages requiring operative control, while the TXA group had none. This difference was statistically significant (Fisher’s, p < 0.05). The attributable risk reduction was 8.4%, with an NNT of 12. This data represents the first PDSA cycle without protocol adjustments.

Conclusions: This single-center, small cohort QI study demonstrates that a postoperative TXA regimen may reduce PTH occurrence. This is the first study examining a postoperative treatment protocol for the prevention of PTH in adults. Replicating this study in a larger patient pool with the aim of refining the protocol is expected to lead to improved tonsillectomy outcomes.