Protocolized tranexamic acid use lowers surgical intervention rates after active post-tonsillectomy hemorrhage: A retrospective cohort study.
Publication/Presentation Date
10-14-2026
Abstract
OBJECTIVE: To evaluate whether a standardized tranexamic acid (TXA) protocol was associated with reduced operative intervention among patients with active post-tonsillectomy hemorrhage (PTH).
METHODS: This retrospective cohort study included patients aged 2 to 21 years with documented active PTH evaluated at a tertiary pediatric otolaryngology service from January 1, 2021, to July 31, 2025. Of 5342 tonsillectomies, 246 patients returned with suspected PTH and 116 met inclusion criteria for active bleeding or clot. A TXA protocol was implemented July 25, 2024. The primary outcome was operative intervention for hemorrhage control. Associations between TXA use, protocol era, route, and operative intervention were analyzed.
RESULTS: Among 116 included patients, operative intervention decreased from 63% before protocol implementation to 40% after implementation (OR 2.50; 95% CI 1.18-5.25; p = .02). Overall, 27 of 30 patients (90%) who did not receive TXA required operative intervention, compared with 33 of 86 patients (38%) who received TXA (OR 0.07; 95% CI 0.02-0.25; p < .001). In adjusted analysis, TXA route was significantly associated with operative intervention (p < .001). Compared with no TXA, nebulized, intravenous, and combined nebulized/intravenous TXA were each associated with lower adjusted odds of operative intervention; stratified analyses suggested nebulized TXA was the most consistent driver.
CONCLUSION: Protocolized TXA use was associated with reduced operative intervention in children and young adults with active PTH, with nebulized TXA showing the strongest association with avoidance of return to the operating room. The study was limited by its retrospective design and utilization of data from a single tertiary center.
Volume
211
First Page
113057
Last Page
113057
ISSN
1872-8464
Published In/Presented At
Short, S. H., Pharr, T., Chaudhry, M., Madera, J. D., & Chennupati, S. K. (2026). Protocolized tranexamic acid use lowers surgical intervention rates after active post-tonsillectomy hemorrhage: A retrospective cohort study. International journal of pediatric otorhinolaryngology, 211, 113057. Advance online publication. https://doi.org/10.1016/j.ijporl.2026.113057
PubMedID
42893660
Department(s)
Department of Pediatrics, Department of Surgery, Medical Education, USF-LVHN SELECT Program, USF-LVHN SELECT Program Faculty, USF-LVHN SELECT Program Students, Department of Pediatrics Faculty, Department of Pediatrics Residents, Fellows and Residents
Document Type
Article