Investigation of the effectiveness of tranexamic acid solution to optimize the control of perioperative bleeding during tonsillectomy

Abstract

Recurrent tonsillitis is one of the most common ORL diseases. Tonsillectomy, as a method of surgical treatment associated with blood loss, and is accompanied by frequent perioperative bleeding. For the control of bleeding, it is advisable to use fibrinolysis inhibitors, one of which is tranexamic acid (TA). The study aimed to optimize the approach to performing tonsillectomy by preoperative application of a TA solution to reduce the volume of perioperative blood loss. Clinical studies were performed in 107 patients with recurrent tonsillitis who underwent bilateral tonsillectomy. The patients were divided into two groups. In the 1st (main) group of 54 patients in the preoperative period was administered a 10% solution of TA at the rate of 10 mg/kg body weight. The 2nd (control) group consisted of 53 patients without the use of TA. The efficacy of using tranexamic acid was evaluated by clinical (surgery time, the volume of blood loss intraoperatively, accounting for postoperative events, evaluation of the incidence of postoperative bleeding), and laboratory data (baseline and postoperative levels of D-dimer, level of soluble fibrin complexes. In group 1, a statistically significant decrease in the volume of blood loss, a decrease in the frequency of occurrence of intraoperative complications, postoperative bleeding, and a reduction in the triviality of the operation were determined. According to laboratory data, in patients of this group, the increase in the content of fibrin lysis products, the extension of thrombin time was significantly less pronounced than in the 2nd comparison group. The use of 10% TA solution before performing bilateral tonsillectomy leads to a decrease in blood loss, frequency, and the degree of occurrence of perioperative complications. Due to this, the duration of the operation of bilateral tonsillectomy is reduced.