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.