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Tranexamic acid – a useful drug in ENT surgery?

Published online by Cambridge University Press:  14 July 2014

P J Robb
P J Robb*
Affiliation:
Department of Otolaryngology, Epsom and St Helier University Hospitals, Epsom, UK
*
Address for correspondence: Mr Peter J Robb, Department of Otolaryngology, Epsom and St Helier University Hospitals, Epsom KT18 7EG, UK Fax: +44 1372 735 048 E-mail: [email protected]
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Abstract

Background:

Tranexamic acid is a synthetic antifibrinolytic drug. It has been widely available for over 40 years, but only recently has it started to be used routinely in many surgical disciplines. For ENT surgeons, epistaxis and post-tonsillectomy bleeding contribute a significant proportion of the morbidity and emergency workload in a general ENT department. Published evidence indicates a potentially helpful role for tranexamic acid in managing epistaxis.

Results and conclusion:

To date, the benefits of tranexamic acid as a prophylactic treatment to reduce the rate and severity of post-tonsillectomy bleeding are less certain. Two recently published pilot studies looking at primary haemorrhage in children and secondary haemorrhage in adults following tonsillectomy suggest that further large, randomised trials should explore the efficacy of tranexamic acid in routine ENT surgery. There are potential reductions in patient morbidity and cost savings if tranexamic acid is found to be efficacious in larger trials.

Keywords

Tranexamic AcidTonsillectomyDay SurgeryHemorrhageComplications
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 128 , Issue 7 , July 2014 , pp. 574 - 579
Copyright
Copyright © JLO (1984) Limited 2014 

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Footnotes

This review is, in part, based on lectures delivered to the Midland Institute of Otology and ENT Scotland annual meetings during the 2013 JLO/RSM Visiting Professors lecture tour.

References

1Bidlingmaier, C, Olivieri, M, Stelter, K, Eberl, W, von Kries, R, Kurnik, K. Postoperative bleeding in paediatric ENT surgery. First results of the German ESPED trial. Hämostaseologie 2010;30(suppl 1):S108–11Google Scholar
2Choudhuri, S, Bolton-Maggs, PHB. Von Willebrand disorder. Paediatr Child Health 2011;21:348–52Google Scholar
3Perel, P, Al-Shahi Salman, R, Kawahara, T, Morris, Z, Prieto-Merino, D, Roberts, I et al. CRASH-2 (Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage) intracranial bleeding study: the effect of tranexamic acid in traumatic brain injury – a nested randomised, placebo-controlled trial. Health Technol Assess 2012;16:iii–x11,1–54Google Scholar
4Gruen, RL, Reade, MC. Administer tranexamic acid early to injured patients at risk of substantial bleeding. BMJ 2012;345:46–7Google Scholar
5WHO Model List of Essential Medicines, 18th edn, 2013. In: http://www.who.int/medicines/publications/essentialmedicines/en/index.html [21 May 2014]Google Scholar
6Verstraete, M. Clinical application of inhibitors of fibrinolysis. Drugs 1985;29:236–61Google Scholar
7Ker, K, Edwards, P, Perel, P, Shakur, H, Roberts, I. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ 2012;344:e3054CrossRefGoogle ScholarPubMed
8Reid, RW, Zimmerman, AA, Laussen, PC, Mayer, JE, Gorlin, JB, Burrows, FA. The efficacy of tranexamic acid versus placebo on decreasing blood loss in pediatric patients undergoing repeat cardiac surgery. Anesth Analg 1997;84:990–6Google Scholar
9Mahdy, AM, Webster, NR. Perioperative systemic haemostatic agents. Br J Anaesth 2004;93:842–58Google Scholar
10Veien, M, Sorensen, JV, Madsen, F, Juelsgaard, P. Tranexamic acid given intraoperatively reduces blood loss after total knee replacement: a randomized, controlled study. Acta Anaesthesiol Scand 2002;46:1206–11CrossRefGoogle ScholarPubMed
11Perel, P, Ker, K, Morales Uribe, CH, Roberts, I. Tranexamic acid for reducing mortality in emergency and urgent surgery. Cochrane Database Syst Rev 2013;(1):CD010245Google Scholar
12Sindet-Pedersen, S, Ramström, G, Bernvil, S, Biombäck, M. Hemostatic effect of tranexamic acid mouthwash in anticoagulant-treated patients undergoing oral surgery. New Engl J Med 1989;320:840–3CrossRefGoogle ScholarPubMed
13Watson, A. Anaesthesia for cleft lip and palate surgery in children. In: James, I, Walker, I, eds. Core Topics in Paediatric Anaesthesia. Cambridge: Cambridge University Press, 2013;228–36CrossRefGoogle Scholar
14Senghore, N, Harris, M. The effect of tranexamic acid (cyclokapron) on blood loss after third molar extraction under a day case general anaesthetic. Br Dent J 1999;186:634–6Google Scholar
15Choi, WS, Irwin, MG, Samman, N. The effect of tranexamic acid on blood loss during orthognathic surgery: a randomized controlled trial. J Oral Maxillofac Surg 2009;67:125–33Google Scholar
16Dunn, CJ, Goa, KL. Tranexamic acid: a review of its use in surgery and other indications. Drugs 1999;57:1005–32Google Scholar
17Femstrual. In: http://femstrual.co.uk/ [22 December 2012]Google Scholar
18Na, JI, Choi, SY, Yang, SH, Choi, HR, Kang, HY, Park, K-C. Effect of tranexamic acid on melasma: a clinical trial with histological evaluation. J Eur Acad Dermatol Venereol 2012;8:1035–9Google Scholar
19Wu, S, Shi, H, Wu, H, Yan, S, Guo, J, Sun, Y et al. Treatment of melasma with oral administration of tranexamic acid. Aesthetic Plast Surg 2012;36:964–70Google Scholar
20Tranexamic acid. In: http://mcbiotec.com/products/?type=detail&id=33 [23 December 2012]Google Scholar
21Modified Release Tranexamic Acid Formulation: US 20120135079 A1. In: http://www.google.com/patents/US20120135079 [22 May 2014]Google Scholar
22Nardi, K, Pelone, G, Bartolo, M, Di, Ruzza, Storto, M, Notte, A et al. Ischaemic stroke following tranexamic acid in young patients carrying heterozygosity of MTHFR C677T. Ann Clin Biochem 2011;48:575–8Google Scholar
23Schneider, JA, Rees, DC, Liu, YT, Clegg, JB. Worldwide distribution of a common methylenetetrahydrofolate reductase mutation. Am J Hum Genet 1998;62:1258–60CrossRefGoogle ScholarPubMed
24Ducloy-Bouthors, A-S, Jude, B, Duhamel, A, Broisin, F, Huissoud, C, Keita-Meyer, H et al. High-dose tranexamic acid reduces blood loss in postpartum haemorrhage. Crit Care 2011;15:R117Google Scholar
25Ronsmans, CI, Graham, WJ; Lancet Maternal Survival Series steering group. Maternal mortality: who, when, where, and why. Lancet 2006;368:1189–200Google Scholar
26Snelgrove, JW. Postpartum haemorrhage in the developing world. A review of clinical management strategies. McGill J Med 2009;12:61–6Google Scholar
27Kalavrouziotis, D, Voisine, P, Mohammadi, S, Dionne, S, Dagenais, F. High-dose tranexamic acid is an independent predictor of early seizure after cardiopulmonary bypass. Ann Thorac Surg 2012;93:148–54Google Scholar
28Guerriero, C, Cairns, J, Jayaraman, S, Roberts, I, Perel, P, Shakur, H. Giving tranexamic acid to reduce surgical bleeding in sub-Saharan Africa: an economic evaluation. Cost Eff Resour Alloc 2010;8:1–11Google Scholar
29Vallamkondu, V, Ah-See, K, Rocke, J, Bannister, M. Tranexamic acid for the prevention and treatment of tonsillectomy-related haemorrhage in adults (Protocols). Cochrane Database Syst Rev 2013;(9):CD010740Google Scholar
30Mazauric, FX, Boudon, A, Rheingold, C. Value of tranexamic acid in extracapsular tonsillectomy in adults [in French]. JFORL J Fr Otorhinolaryngol Audiophonol Chir Maxillofac 1973;22:165–8Google Scholar
31Verstraete, M, Tyberghein, J, De Greef, Y, Daems, L, Van Hoof, A. Double-blind trials with ethamsylate, batroxobin or tranexamic acid on blood loss after adenotonsillectomy. Acta Clin Belg 1977;32:136–40Google Scholar
32Castelli, G, Vogt, E. Result of an antifibrinolytic treatment using tranexamic acid for the reduction of blood loss during and after tonsillectomy [in German]. Schweiz Med Wochenschr 1977;107:780–4Google Scholar
33George, A, Kumar, R, Kumar, S, Shetty, S. A randomized control trial to verify the efficacy of pre-operative intra venous tranexamic acid in the control of tonsillectomy bleeding. Indian J Otolaryngol Head Neck Surg 2011;63:20–6Google Scholar
34Brum, MR, Miura, MS, de Castro, SM, Machado, M, Lima, LH, Faibes, J et al. Tranexamic acid in adenotonsillectomy: a double-blind randomized clinical trial. Int J Pediatr Otorhinolaryngol 2012;76:1401–5Google Scholar
35Chan, CC, Chan, YY, Tanweer, F. Systematic review and meta-analysis of the use of tranexamic acid in tonsillectomy. Eur Arch Otorhinolaryngol 2013;270:735–48Google Scholar
36Falbe-Hansen, J Jr, Jacobsen, B, Lorenzen, E. Local application of an antifibrinolytic in tonsillectomy. A double-blind study. J Laryngol Otol 1974;88:565–8Google Scholar
37Scottish Intercollegiate Guidelines Network. Management of Sore Throat and Indications for Tonsillectomy: A National Clinical Guideline (National Clinical Guideline 117). Edinburgh: SIGN, 2010Google Scholar
38Robb, PJ, Bew, S, Kubba, H, Murphy, N, Rollin, AM, Tremlett, M. Tonsillectomy and adenoidectomy in children with sleep-related breathing disorders: consensus statement of a UK multidisciplinary working party. Ann R Coll Surg Engl 2009;91:371–3Google Scholar
39Robb, PJ, Thorning, G. Perioperative tranexamic acid in day-case paediatric tonsillectomy. Ann R Coll Surg Engl 2014;96:127–9CrossRefGoogle ScholarPubMed
40National Institute for Health and Clinical Excellence. Suction Diathermy Adenoidectomy (Interventional procedure guidance 328). London: NICE, 2009Google Scholar
41Robb, PJ, Ewah, BN. Post-operative nausea and vomiting following paediatric day-case tonsillectomy: audit of the Epsom protocol. J Laryngol Otol 2011;125:1049–52Google Scholar
42Codeine for analgesia: restricted use in children because of reports of morphine toxicity. In: http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON296400 [3 August 2013]Google Scholar
43Robb, PJ, Ewah, B. Can tranexamic acid reduce bleeding after tonsillectomy? A pilot study. Otorinolaringologia 2013;63:163–7Google Scholar
44Windfuhr, J, Seehafer, M. Classification of haemorrhage following tonsillectomy. J Laryngol Otol 2001;115:457–61Google Scholar
45Albirmawy, OA, Saafan, M, Shehata, EM, Basuni, AS, Eldaba, AA. Topical application of tranexamic acid after adenoidectomy: a double-blind, prospective, randomized, controlled study. Int J Pediatr Otorhinolaryngol 2013;77:1139–42Google Scholar
46Bennett, JDC, Giangrande, PLF. Nosebleeds – the importance of taking a history. J R Army Med Corps 1990;136:167–9Google Scholar
47Joseph, J, Martinez-Devesa, P, Perera, R. Antifibrinolytic agent tranexamic acid for nasal haemorrhage (epistaxis). Cochrane Database Syst Rev 2010;(12):CD004328Google Scholar
48Zahed, R, Moharamzadeh, P, Alizadeharasi, S, Ghasemi, A, Saeedi, M. A new and rapid method of epistaxis treatment using injectable form of tranexamic acid topically: a randomized controlled trial. Am J Emerg Med 2013;31:1389–92CrossRefGoogle ScholarPubMed
49Langille, MA, Chiarella, A, Côté, DWJ, Mulholland, G, Sowerby, LJ, Dziegielewski, PY et al. Intravenous tranexamic acid and intraoperative visualization during functional endoscopic sinus surgery: a double-blind randomized controlled trial. Int Forum Allergy Rhinol 2013;3:315–18Google Scholar
50Chhapola, S, Matta, I. Short-term use of tranexamic acid to reduce blood loss in endoscopic nasal surgeries. Clinical Rhinology: An International Journal 2011;55:20–7Google Scholar
51Thongrong, C, Kasemsiri, P, Carrau, RL, Bergese, SD. Control of bleeding in endoscopic skull base surgery: current concepts to improve hemostasis. ISRN Surg 2013;2013:191543Google Scholar
52Parmar, A, Hanks, K-A, Muir, J, Evans, K. The true cost of post-tonsillectomy bleeds. Clin Otolaryngol 2013;38:106–7Google Scholar
53General Election 2010: frequently asked questions. In: http://www.kingsfund.org.uk/projects/general-election-2010/faqs#hospital [18 March 2013]Google Scholar
54British National Formulary. In: http://www.nice.org.uk/mpc/BritishNationalFormulary.jsp [22 May 2014]Google Scholar