The Effect of Topical Tranexamic Acid in Reducing Bleeding During and After Tonsillectomy: A Triple-Blind Randomized Placebo-Controlled Trial

Tonsillectomy is one of the most common head and neck surgeries that may be associated with significant bleeding. Tranexamic acid (TXA) is recognized as an effective intervention for reducing bleeding during surgeries. This study aims to investigate the effect of topical tranexamic acid on reducing bleeding during and after tonsillectomy surgery. This study was conducted randomly and double-blind on 60 candidates for tonsillectomy. The patients were divided into two groups: the control group (30 individuals), which received normal saline, and the intervention group (30 individuals), which received topical tranexamic acid before the start of the surgery. The amount of bleeding during and after surgery, length of hospital stays, and side effects were evaluated as study outcomes. The average age in the intervention group (tranexamic acid) was 7.63 years, and in the control group (normal saline), it was 7.33 years, with no significant difference (p = 0.441). The average bleeding during the operation was 18.5 cc in the intervention group and 17.67 cc in the control group (p = 0.361). No early bleeding was observed within 24 h post-operation, and only one case was recorded in the intervention group within a week after the surgery. Neither group required blood transfusions or hospitalization, and all patients adhered to dietary restrictions and antibiotic use. In conclusion, this study, which aimed to investigate the effect of topical tranexamic acid on reducing bleeding during and after tonsillectomy surgery, found that the topical administration of tranexamic acid (TXA) did not show superiority over placebo in controlling bleeding. Specifically, no significant differences were observed between the two groups regarding hemodynamic side effects and instances of re-bleeding. This suggests that although TXA is commonly used for managing bleeding in various surgeries, its effectiveness in tonsillectomy procedures may be limited, necessitating further research to determine its overall utility.