Postoperative bleeding in otolaryngologic procedures causes delayed discharge, requires re-admission and adds considerably to the cost of patient care. Whether the anti-fibrinolytic activity of tranexamic acid should be used routinely to prevent haemorrhagic complications after ENT operations is speculation but the author has given several examples of this practice being prevalent in other specialities and describes a number of studies supporting its role in reducing blood loss without causing thromboembolic complications. Tranexamic acid has been used in cleft palate and cardiac surgery, knee replacements, management of trauma patients and post-partum haemorrhage. Transfusion of blood has several risks in itself and this may be avoided with use of tranexamic acid. Use of tranexamic acid in tonsillectomy has been shown to reduce operative and immediate postoperative blood loss thus facilitating same day discharge but it does not prevent secondary haemorrhage. Irrigation of the nasopharynx with tranexamic acid after adenoidectomy reduced blood loss in one study. In a randomised controlled trial a single intravenous injection of tranexamic acid proved more effective than anterior nasal packing and similar encouraging results have been seen in functional endoscopic sinus surgery. The cost effectiveness of using tranexamic acid has been suggested by estimating savings achieved by avoiding post tonsillectomy haemorrhage. The author believes that in tonsillectomy haemorrhage, expenditure could be reduced from £8 million to £0.23 million. Side-effects of tranexamic acid are discussed, mainly thromoembolic phenomenon and gastrointestinal upsets, but the incidence of these is low.
Use of tranexamic acid in ENT surgery
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