Tranexamic acid for post-?tons”>American Journal of Emergency Medicine 38 (2020) 1943

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Nebulized tranexamic acid for

post-tonsillectomy hemorrhage in children:

a promising game changer

Dear Sir,

Hemorrhage after tonsillectomy can be a life-threatening condition in the pediatric population [1]. Several interventions have been used to prevent and treat this Life-threatening bleeding; however, in cases of severe hemorrhage, most of them are not effective in controlling bleeding and this could put a lot of stress on emergency physicians and nurses. Therefore, due to the high risk of postoperative hemorrhage, it is still necessary to discover fast-acting and efficacious treatments.

One of the fast-acting therapies for controlling bleeding in major sur-

geries is the use of tranexamic acid, which is a synthetic lysine analog that inhibits the activation of plasminogen [2]. Tranexamic acid, both in- travenously and topically, has been extensively used for preventing and controlling hemorrhagic conditions in the adult population such as car- diothoracic, neurosurgeries, otolaryngeal and orthopedic surgeries [3,4]. However, its usage in the pediatric population is limited to major cases such as orthopedic and craniofacial surgeries [5]. Based on the limited evidence, nebulized tranexamic acid has been used for ter- minating pharyngeal and otolaryngeal hemorrhage in the adult and dif- fuse alveolar hemorrhage in children [6,7]. In a most recent case study of a three years old boy, nebulized tranexamic acid showed promising re- sults to control bleeding in a patient with massive post-tonsillectomy hemorrhage [8]. In this case, tranexamic acid was directly nebulized at 250 mg and the bleeding was ended within the 7 min of nebulization. The interesting thing was that nebulized tranexamic acid appears to be safe, with no systemic or local adverse effects. Although little evi- dence is available, the results of this preliminary case study indicate the effectiveness of this treatment in controlling severe post- tonsillectomy hemorrhage. Accordingly, evaluating the safety and effi- cacy of nebulized tranexamic acid in controlling hemorrhage among pe- diatric patients after tonsillectomy is of particular interest, and the results of the case study provide some important insights for future in- vestigation. In addition to evaluating its efficacy, the best dosage and the best temperature of solution for nebulization needs to be evaluated.

Declaration of funding

Nil.

Declaration of competing interest

The authors declare that there is no conflict of interest regarding the publication of this paper. In addition, they have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript.

References

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   Bafaqih H, Chehab M, Almohaimeed S, Thabet F, Alhejaily A, AlShahrani M, et al. Pilot trial of a novel two-step therapy protocol using nebulized tranexamic acid and re- combinant factor VIIa in children with intractable diffuse alveolar hemorrhage. Ann Saudi Med 2015;35(3):231-9.

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   Touraj Assadi MD

   Department of Emergency Medicine, Faculty of Medicine, Mazandaran

   University of Medical Sciences, Sari, Iran E-mail address: [email protected].

   12 January 2020

   https://doi.org/10.1016/j.ajem.2020.01.042

   0735-6757/(C) 2020