DOI: https://doi.org/10.53350/pjmhs22167799 ORIGINAL ARTICLE P J M H S Vol. 16, No. 07, July 2022 799 Compare Mean Blood Loss in Patients Undergoing Tonsillectomy with and without Tranexamic Acid MUHAMMAD ASIF ASHRAF 1 , ISHFAQ AHMED 2 , SANAULLAH BHATTI 3 , DEEPAK RAI 4 , SARA SAMAD QURESHI 5 , RANA FARRUKH TASLEEM 6 1 Senior Registrar, Department of ENT, Bakhtawar Amin Trust and teaching Hospital, Multan 2 Assistant Professor, Department of ENT, Bilawal Medical HospitalKotri, LUMHS 3 Assistant professor, Department of ENT, Bakhtawar Amin Trust and teaching Hospital, Multan 4 Senior registerar, Department of ENT, United medical and dental college Karachi 5 Senior Registrar, Department of ENT, Bakhtawar Amin Trust and teaching Hospital, Multan 6 Consultant ENT specialist, MBBS, FCPS, Health Department Multan Punjab Corresponding author: Ishfaq Ahmed, Email: Ishfaqarain37@Yahoo.Com ABSTRACT Introduction: Tonsillectomy is one of the most common surgeries in ENT department and bleeding is one of the most serious complications related to tonsillectomy. Tranexamic acid is a plasminogen inhibitor which has been successfully used to control bleeding in a variety of surgeries. Objective: The objective of this study is to compare mean blood loss in patients undergoing tonsillectomy with and without Tranexamic acid. Study Design: Randomized controlled trail Setting: This study was carried out at the Department of ENT Jinnah Hospital Lahore Sample Technique: Non-probability, consecutive sampling Study Duration: The study was done in 6 months after the approval of synopsis [March 8, 2017 till September 8, 2017] Materials and Methods: Sixty Patients were randomly divided into 2 equal groups using lottery method in group-A and group- B. Patients in Group-A received tranexamic acid after induction intravenously as 15 mg/kg (single bolus dose) over 10 min. Patients in group B were served as control group and they did not receive tranexamic acid before tonsillectomy. All surgeries were carried out by a single consultant having more than 5 years of experience after post-graduation. Blood loss was measured by researcher himself as per operational definition. Results: The mean age of cases in Tranexamic group was 19.70 ± 12.12 years while in control group was 21.53 ± 15.44 years. In Tranexamic acid group there were 18(60%) male and 12(40%) female cases while in control group there were 21(70%) male and 9(30%) female cases. The mean blood loss in Tranexamic acid group were 30.27 ±8.85 ml and in control group was 67.67 ± 14.91 ml. The mean blood loss was significantly less in Tranexamic acid group as compared to control group, p-value < 0.05. Conclusion: The mean blood loos in cases with Tranexamic acid were significantly lower as compared to control group. So in future every patient selected for tonsillectomy must be given TXA to reduce the blood transfusion and related complications of the patients. Keywords: ENT, Tonsillectomy, Bleeding, blood transfusion, Tranexamic acid INTRODUCTION With a prevalence of 20%-40% of all surgical procedures in otolaryngology [1-2], tonsillectomy is one of the most common surgical procedures performed. Significant morbidity and probable complications are part of the tonsillectomy post-operative course. Researchers and surgeons have been working to improve tonsillectomy techniques throughout the years in an effort to lessen the risk of complications after the procedure. Having your tonsils removed should be a quick, painless, and mostly trouble-free procedure [3]. Hemorrhage is possible during or after a tonsillectomy. Hemorrhage that occurs more than 24 hours following surgery is classified as secondary haemorrhage (more than 24 h after surgery, typically one week postoperative). Blood loss during surgery is managed intraoperatively [1]. Although tranexamic acid (TXA) has been around for more than 40 years, its value as a pharmaceutical tool for minimising blood loss during surgery and after severe trauma has just lately been recognised [4]. Although TXA has a clinical indication for preventing and reducing bleeding following tonsillectomy [4-5], it is not commonly used for this purpose. Epistaxis and post- tonsillectomy bleeding account for a sizable fraction of ENT surgeons' morbidity and emergency workload [6]. Blood loss in a recent study across all ages was reported to be 36.6423.76 ml in the study group and 66.3229.59 ml in the control group (notice that they did not report standard deviation along with the mean; we did so using the data they supplied in their paper) [7]. The purpose of this research was to determine if Tranexamic acid had any effect on postoperative bleeding in patients who had had tonsillectomy. Unfortunately, we were only able to locate a single international study that looked at the effectiveness of TXA in reducing blood loss in patients who had undergone tonsillectomy, and they preferred the function of TXA. 7 Tonsillectomy is a common procedure, and significant bleeding is a potential risk, thus this study will help us understand the significance of TXA in our local population undergoing tonsillectomy. The plasminogen inhibitor tranexamic acid has been used effectively to manage blood loss throughout a wide variety of medical procedures. Once we determine whether or not TXA reduces blood loss during tonsillectomy, it will be routinely administered to all patients who qualify for the procedure in an effort to cut down on the number of patients who require a blood transfusion and the difficulties that come with it. MATERIALS AND METHODS This randomized controlled trial was conducted at Department of ENT Jinnah Hospital Lahore during from the period March 8, 2017 to September 8, 2017. Total 60 patients of either gender with ASA physical status I–II undergoing tonsillectomy due to acute tonsillitis were included. Patient’s ages were ranging between 4-45 years. All patients having Hb < 11 at the time of surgery, patients with known history of liver or kidney dysfunction (was assessed on available clinical record) [AST / ALT > 4, IU, urea > 20 mg/dl, creatinine > 1-3 mg/dl], patients with inherited coagulopathy or preoperative use of anticoagulant therapy within 5 days before surgery, allergy to Tranexamic acid, and patients with history of neurologic or psychiatric disease were excluded. A prior informed consent was obtained from patients and attendants before obtaining information such as their names, ages, prevision C-sections, parities, gestational ages, and contact information. Patients were assigned to one of two groups using a lottery system: group A or group B. Both groups had the same number of members. After the induction, patients in Group-A were given tranexamic acid intravenously at a dose of 15 mg/kg as a