Topical application of tranexamic acid after adenoidectomy: a double-blind, prospective, randomized, controlled study.

Albirmawy OA, Saafan ME, Shehata EM, Basuni AS, Eldaba AA
Int J Pediatr Otorhinolaryngol 2013;77:1139-1142.
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Review by : J. Lacroix
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Albirmawy and colleagues completed a randomized double-blind controlled clinical trial evaluating the efficacy of topical tranexamic acid to prevent post-adenoidectomy hemorrhage. 400 children were enrolled. Post-adenoidectomy hemorrhage was observed in 5 of 200 children in the experimental group and in 12 of 200 children in the control group (P = 0.03); 5 bleedings were massive, 1 in the experimental vs. 4 in the control group (not statistically significant).

This important study suggests that tranexamic acid might be a useful preventive measure of post-adenoidectomy hemorrhage. However, the results should not be considered definitive because there are many important weaknesses. For example, it seems that sample size was not determined a priori, the study was not registered before it started and no attention was paid to side effects. Moreover, the difference in the volume of bleeding was indeed statistically significant (19 ± 2.5 vs. 26 ± 4.3 mL; P = 0.03), but it was not clinically significant (only 7 mL). Other randomized controlled trials must be conducted before tranexamic acid can be recommended to prevent post-adenoidectomy hemorrhage.

– Jacques Lacroix