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Tranexamic acid in Otorhinolaryngology - A contemporary review

Jordan Fuzi

CTranexamic acid is an anti-fibrinolytic agent which has been proven beneficial in multiple surgical specialties where significant bleeding can occur. Whilst it has been widely available for over 40 years, its use within Otorhinolaryngology remains limited. Operations in Otorhinolaryngology are particularly varied with some such as tonsillectomy having the potential for significant lifethreatening bleeding (1). Other operations are performed within small confined surgical fields and even small amounts of bleeding can significantly detriment surgical field, increase technical difficulty and prolong operative time (2). A review of the medical literature was performed to evaluate the current evidence on the benefits of tranexamic acid within the field of Otorhinolaryngology and Head and Neck Surgery. A total of 52 studies were included within this review. Tranexamic Acid was demonstrated to be a safe drug with no major adverse effects or significant thromboembolic events reported with its use in Otorhinolaryngology. This drug has been shown to be of particular benefit in rhinology by improving surgical field, reducing operative time and reducing postoperative swelling and ecchymosis (3,4). Additionally, its use was associated with a significantly reduced rate and degree of postoperative swelling and ecchymosis after nasal surgery. The benefit of Tranexamic Acid use in tonsillectomy is less clear and further studies are required to evaluate its potential use in the reduction of post tonsillectomy haemorrhage rates (5). Overall, Tranexamic Acid has been demonstrated to be a safe drug for use in Otorhinolaryngology. Whilst its benefit in rhinology has been clearly demonstrated, further studies are required to quantify its utility in other areas of Otorhinolaryngology.