You’re under arrest, you damned post-tonsillectomy bleed!
Reviewed by Thomas William Binnersley

Tonsillectomy is a common, well-tolerated procedure most commonly performed in children for recurrent tonsilitis and sleep apnoea. Post-tonsillectomy bleeding (PTB) is a relatively uncommon complication that poses significant risks to patients and high rates of readmission and reintervention. Institutional guidance on the prevention and management of post-tonsillectomy bleeds is variable and often involves the use of tranexamic acid (TXA). However, the evidence for its use is limited. Tesema and colleagues performed a scoping review of its effectiveness. The authors reviewed 24 articles encompassing 96,052 mainly paediatric tonsillectomy patients. TXA was given topically, orally or via a nebuliser, but intravenous administration before or immediately after surgery was the most common preventative strategy. Prophylactic TXA modestly reduced intraoperative blood loss and sometimes reduced rates of postoperative reintervention. When secondary haemorrhages struck after discharge, nebulised TXA was often employed in emergency settings, rapidly achieving haemostasis and sparing many patients from a return to theatre. The authors highlight the difficulty in comparing outcomes using TXA in PTB given the wide variability in dosing, administration and operative technique. Additionally, PTB in adults is over three times more likely to require a return to theatre than in children, a fact I believe may be masked by this study’s predominantly paediatric patient pool. TXA, beloved by bleeders everywhere and those who manage them, may certainly have a place in PTB, but we must have more research tailored to specific age ranges and operative techniques.

The Use of Tranexamic Acid for Post-tonsillectomy Hemorrhage in Pediatric Patients: A Scoping Review.
Tesema N, Hasnie S, Wright-Powers L, et al.
ANN OF OTOL RHINOL LARYNGOL 
2025;134(10):744–53.