Use of nebulized tranexamic acid in adult and pediatric post-tonsillectomy hemorrhage

Purpose: Post-tonsillectomy hemorrhage is a serious complication and is one of the most common reasons for emergency department visits following tonsillectomy. A percentage of these patients require a return trip to the operating room for hemostasis. A variety of methods exist for control of post-tonsillectomy hemorrhage. We report the use of nebulized tranexamic acid (TXA) in two adult and two pediatric patients who presented with post-tonsillectomy hemorrhage. Methods: A retrospective chart review was conducted on four patients at two tertiary care hospital centers. Patients were identified if they experienced post-tonsillectomy hemorrhage and were administered nebulized TXA during their hospital course for bleeding control. Results: Two pediatric (8 and 15 years old) and two adult (27 and 31 years old) patients who presented to the emergency department with post-tonsillectomy hemorrhage were treated with 500 mg of nebulized TXA. All patients had previously undergone extracapsular tonsillectomy. One patient required additional bedside cautery with silver nitrate after nebulized TXA, but no patients required a return trip to the operating room. No patients experienced adverse medication side effects. Conclusions: In this study we report on the use of nebulized TXA in a series of patients with post-tonsillectomy hemorrhage. All patients presented with significant post-tonsillectomy hemorrhage and were successfully managed without a return trip to the operating room. One patient required bedside silver nitrate cautery in addition to nebulized TXA. Additional studies need to be performed to confirm safety and efficacy of this potential new modality.