title: Systematic review and meta-analysis of the use of tranexamic acid in tonsillectomy.
abstract: Post-tonsillectomy haemorrhage is a serious complication that can lead to death despite the fact that tonsillectomy is one of the commonest procedures performed in otolaryngology. Post-operative haemorrhage can be reduced by a potent antifibrinolytic agent such as tranexamic acid (TXA). This systematic review aims to evaluate the role of TXA in tonsillectomy. Searches were performed on MEDLINE, EMBASE, Web of Science and the Cochrane Library. Study selection, data extraction and quality assessment were conducted independently by two reviewers. Mean difference (MD) in volume of blood loss was calculated with 95 % confidence interval (CI). Risk ratios (RR) with 95 % CI were computed using random effects for the risk of post-tonsillectomy haemorrhage. This review identified and included a total of seven studies. Two studies (n = 180) compared the effects of TXA on volume of blood loss. Meta-analysis of these studies showed a significant decrease in the mean blood loss of 32.72 ml (95 % CI -42.66 to -22.78, p < 0.00001). Five studies (n = 1,670) compared the number of patients with post-tonsillectomy haemorrhage between TXA and control groups. TXA does not reduce the number of patients with post-tonsillectomy haemorrhage significantly (RR = 0.51, 95 % CI 0.25 to 1.07, p = 0.08). TXA led to a significant reduction of tonsillectomy blood loss volume but had no impact on the rate of patients with post-tonsillectomy haemorrhage. This systematic review demonstrated that most studies were conducted before 1980; therefore, a new, large and well-designed randomised controlled trial is needed to investigate the risks and benefits of TXA.
authors.affiliation: Head and Neck Research Group, Castle Hill Hospital, Second Floor, Daisy Building, Cottingham, HU16 5JX, UK. chancheeching@gmail.com
authors.forename: Chee Ching
authors.initials: CC
authors.lastname: Chan
authors.forename: Yee Yin
authors.initials: YY
authors.lastname: Chan
authors.forename: Faiz
authors.initials: F
authors.lastname: Tanweer
mesh_terms: D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D006801:Humans; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D014068:Tonsillectomy; D014148:Tranexamic Acid / Q000627:therapeutic use*
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid