Introduction
Post-operative haemorrhage in thyroid surgery is a serious complication that can lead to significant airway compromise and even rarely death. Several intraoperative techniques are used to minimise the risk of bleeding. There is evidence for the use of tranexamic acid (TXA) to reduce blood loss in surgery.1 TXA is used intravenously or topically in many different surgical specialties including orthopaedics, and cardiothoracic.2-3 In Ear, Nose and Throat (ENT), tranexamic acid is commonly used in the management of epistaxis and has been investigated for use in tonsillectomy.4-5
TXA is a synthetic antifibrinolytic agent. In the clotting cascade, it acts as a binder at the lysine site on plasminogen. This prevents fibrinolysis and can inhibit plasminogen from dissolving clots, potentially reducing bleeding.6 Adverse effects of TXA are uncommon; the most frequent is nausea, which is usually caused by rapid intravenous administration.6 Concerns have been raised previously about the risk of thromboembolic events, however Myles et al. looked at the use of TXA in at-risk patients undergoing coronary-artery surgery and found no increased risk of thrombotic complications. 3
In this study, we review our outcomes of postoperative haematoma following the administration of perioperative tranexamic acid during thyroid surgery.