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Aim <p>The aim of this study was to conduct a systematic review of the available literature evaluating the effectiveness and safety of nebulized (inhaled) tranexamic acid in the treatment of post-tonsillectomy hemorrhage in both pediatric and adult populations.</p> Material and Methods <p>A systematic literature review was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed databases were searched for publications from 2015 to 2025 using structured Boolean search strategies. The PICOS framework was applied to define population, intervention, comparator, outcomes, and study design criteria. Three PubMed searches yielded a total of 79 records. After removal of 42 duplicates, 37 unique publications were screened. Following title/abstract screening and full-text assessment, 13 studies met the inclusion criteria and were included in the qualitative analysis, comprising retrospective cohort studies, case series, case reports, a quality improvement initiative, a meta-analysis, and a narrative review.</p> Results <p>Available studies indicate that nebulized TXA achieves effective hemostasis in approximately 67–80% of PTH cases without the need for surgical intervention. Reoperation rates were significantly lower in TXA-treated groups compared to controls (28% vs. 39%, p &lt; 0.05 in one cohort). In pediatric populations, multiple studies demonstrated hemostasis rates of 74–80% after a single nebulized dose. Adult data, though more limited, showed bleeding cessation in 76% of cases. Meta-analytical evidence confirmed that nebulized TXA does not increase thromboembolic risk, with adverse effects limited to mild throat irritation and transient cough.</p> Conclusions <p>Nebulized tranexamic acid appears to be an effective and safe adjunct in the management of acute post-tonsillectomy hemorrhage in both pediatric and adult patients. It reduces the need for reoperation and is associated with a low rate of adverse events. Further high-quality randomized controlled trials are needed to standardize dosing protocols and to define the optimal role of nebulized TXA within PTH treatment algorithms.</p>

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Evaluation of the Effectiveness of Nebulized Tranexamic Acid as a Treatment for Post-tonsillectomy Hemorrhage: A Systematic Literature Review

  • 期刊论文

  • 发表日期：

    2026年6月26日

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  • Katarzyna Zyzynska,
  • Kamila Grycner,
  • Dmitry Tretiakow,
  • Andrzej Skorek

摘要

Aim

The aim of this study was to conduct a systematic review of the available literature evaluating the effectiveness and safety of nebulized (inhaled) tranexamic acid in the treatment of post-tonsillectomy hemorrhage in both pediatric and adult populations.

Material and Methods

A systematic literature review was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed databases were searched for publications from 2015 to 2025 using structured Boolean search strategies. The PICOS framework was applied to define population, intervention, comparator, outcomes, and study design criteria. Three PubMed searches yielded a total of 79 records. After removal of 42 duplicates, 37 unique publications were screened. Following title/abstract screening and full-text assessment, 13 studies met the inclusion criteria and were included in the qualitative analysis, comprising retrospective cohort studies, case series, case reports, a quality improvement initiative, a meta-analysis, and a narrative review.

Results

Available studies indicate that nebulized TXA achieves effective hemostasis in approximately 67–80% of PTH cases without the need for surgical intervention. Reoperation rates were significantly lower in TXA-treated groups compared to controls (28% vs. 39%, p < 0.05 in one cohort). In pediatric populations, multiple studies demonstrated hemostasis rates of 74–80% after a single nebulized dose. Adult data, though more limited, showed bleeding cessation in 76% of cases. Meta-analytical evidence confirmed that nebulized TXA does not increase thromboembolic risk, with adverse effects limited to mild throat irritation and transient cough.

Conclusions

Nebulized tranexamic acid appears to be an effective and safe adjunct in the management of acute post-tonsillectomy hemorrhage in both pediatric and adult patients. It reduces the need for reoperation and is associated with a low rate of adverse events. Further high-quality randomized controlled trials are needed to standardize dosing protocols and to define the optimal role of nebulized TXA within PTH treatment algorithms.