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Systematic review and meta-analysis of the use of tranexamic acid in tonsillectomy

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Abstract

Post-tonsillectomy haemorrhage is a serious complication that can lead to death despite the fact that tonsillectomy is one of the commonest procedures performed in otolaryngology. Post-operative haemorrhage can be reduced by a potent antifibrinolytic agent such as tranexamic acid (TXA). This systematic review aims to evaluate the role of TXA in tonsillectomy. Searches were performed on MEDLINE, EMBASE, Web of Science and the Cochrane Library. Study selection, data extraction and quality assessment were conducted independently by two reviewers. Mean difference (MD) in volume of blood loss was calculated with 95 % confidence interval (CI). Risk ratios (RR) with 95 % CI were computed using random effects for the risk of post-tonsillectomy haemorrhage. This review identified and included a total of seven studies. Two studies (n = 180) compared the effects of TXA on volume of blood loss. Meta-analysis of these studies showed a significant decrease in the mean blood loss of 32.72 ml (95 % CI −42.66 to −22.78, p < 0.00001). Five studies (n = 1,670) compared the number of patients with post-tonsillectomy haemorrhage between TXA and control groups. TXA does not reduce the number of patients with post-tonsillectomy haemorrhage significantly (RR = 0.51, 95 % CI 0.25 to 1.07, p = 0.08). TXA led to a significant reduction of tonsillectomy blood loss volume but had no impact on the rate of patients with post-tonsillectomy haemorrhage. This systematic review demonstrated that most studies were conducted before 1980; therefore, a new, large and well-designed randomised controlled trial is needed to investigate the risks and benefits of TXA.

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Acknowledgments

This research was undertaken as part of the third year of MSc in Surgical Sciences of Edinburgh Surgical Sciences Qualification. The authors appreciated the support and assistance provided by members of the e-tutors team throughout the course of the project. Appreciation was also given to Pfizer® for providing product information.

Conflict of interest

All authors declared no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years, and no other relationships or activities that could appear to have influenced the submitted work.

Author information

Authors and Affiliations

  1. Head and Neck Research Group, Castle Hill Hospital, Second Floor, Daisy Building, Cottingham, HU16 5JX, UK

    Chee Ching Chan

  2. Department of Obstetrics and Gynaecology, Queen’s Medical Centre Campus, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG72UH, UK

    Yee Yin Chan

  3. Department of Ear, Nose and Throat, Leicester Royal Infirmary, Leicester, LE1 5WW, UK

    Faiz Tanweer

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  1. Chee Ching Chan
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Correspondence to Chee Ching Chan.

Appendices

Appendix A: Search strategy

Database: Ovid MEDLINE(R) Daily Update <August 12, 2011>, Ovid MEDLINE(R) In-Process and Other Non-Indexed Citations and Ovid MEDLINE(R) <1948 to present>, Embase <1947 to 2011 August 12>

Search strategy

  1. 1.

    Tonsillectom$.mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (18060)

  2. 2.

    Tranexamic.mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (7406)

  3. 3.

    Amca.mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (503)

  4. 4.

    AMCHA.mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (263)

  5. 5.

    Amchafibrin.mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (15)

  6. 6.

    Aminomethylcyclohexanecarbonic.mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (1)

  7. 7.

    (Aminomethylcyclohexane adj carbonic).mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (1)

  8. 8.

    (Methylcyclohexane adj carboxylate).mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (4)

  9. 9.

    Aminomethylcyclohexanecarboxylic.mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (48)

  10. 10.

    (Aminomethyl adj cyclohexane adj carboxylic).mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (62)

  11. 11.

    (Aminomethyl adj cyclohexanecarboxylic).mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (56)

  12. 12.

    (Aminomethylcyclohexane adj carboxylic).mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (17)

  13. 13.

    Aminomethylcyclohexanecarboxylic.mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (48)

  14. 14.

    Aminomethylcyclohexanoic.mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (1)

  15. 15.

    Amstat.mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (1)

  16. 16.

    Anvitoff.mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (38)

  17. 17.

    Cl65336.mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (0)

  18. 18.

    Cyclocapron.mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (95)

  19. 19.

    Cyclokapron.mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (185)

  20. 20.

    Cyklocapron.mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (21)

  21. 21.

    Cyklokapron.mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (242)

  22. 22.

    Exacyl.mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (97)

  23. 23.

    Frenolyse.mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (22)

  24. 24.

    Hexacapron.mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (3)

  25. 25.

    Hexakapron.mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (5)

  26. 26.

    Tranex.mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (15)

  27. 27.

    Tranexanic.mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (6)

  28. 28.

    (Trans adj achma).mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (0)

  29. 29.

    Transamin.mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (77)

  30. 30.

    (Transaminomethylcyclohexane adj carboxylic).mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (1)

  31. 31.

    Transexamic.mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (15)

  32. 32.

    Ugurol.mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (75)

  33. 33.

    Transcam.mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (2)

  34. 34.

    Femstrual.mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (0)

  35. 35.

    Cyclo-f.mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (15)

  36. 36.

    Lysteda.mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (15)

  37. 37.

    Espercil.mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (0)

  38. 38.

    2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24 or 25 or 26 or 27 or 28 or 29 or 30 or 31 or 32 or 33 or 34 or 35 or 36 or 37 (7985)

  39. 39.

    1 and 38 (38)

  40. 40.

    Amikapron.mp. [mp = ps, rs, ti, ot, ab, nm, hw, ui, an, sh, tn, dm, mf, dv, kw] (6)

  41. 41.

    38 or 40 (7985)

  42. 42.

    1 and 41 (38)

Appendix B

See Table 6.

Table 6 Preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement
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Chan, C.C., Chan, Y.Y. & Tanweer, F. Systematic review and meta-analysis of the use of tranexamic acid in tonsillectomy. Eur Arch Otorhinolaryngol 270, 735–748 (2013). https://doi.org/10.1007/s00405-012-2184-3

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