European Archives of Oto-Rhino-Laryngology

, Volume 276, Issue 1, pp 249–254 | Cite as

Tranexamic acid and post-tonsillectomy hemorrhage: propensity score and instrumental variable analyses

  • Megumi KoizumiEmail author
  • Miho Ishimaru
  • Hiroki Matsui
  • Kiyohide Fushimi
  • Tatsuya Yamasoba
  • Hideo Yasunaga



Although post-tonsillectomy hemorrhage occurs rarely, it can be life-threatening. Previous studies showed that tranexamic acid (TXA) had insignificant association with the rate of post-tonsillectomy hemorrhage, but those findings were limited by small sample sizes. The purpose of this study was to examine the effectiveness of TXA in preventing post-tonsillectomy hemorrhage using nationwide database.


Data of a retrospective cohort of 117,598 patients from 750 hospitals, who had undergone tonsillectomy between 2010 and 2016, were drawn from the Diagnosis Procedure Combination database in Japan and studied.


Propensity score-matched analysis showed no significant differences in proportions of reoperation or blood transfusion after tonsillectomy between the treatment (TXA from the day of tonsillectomy) and control groups (1.50% vs. 1.47%, p = 0.64). Instrumental variable analysis also showed no significant differences (odds ratio, 0.98; 95% confidence interval, 0.86–1.13; p = 0.82). Higher proportions of reoperation or blood transfusion were significantly associated with male sex, older age, emergency hospitalization, prolonged anesthesia, and medium hospital volume (annual number of tonsillectomies).


Administration of TXA from the day of tonsillectomy is not associated with reduction in reoperation or blood transfusion rates.


Post-tonsillectomy hemorrhage Tranexamic acid Reoperation for hemostasis Propensity score matching Instrumental variable analysis 



Contract grant sponsor: This work was supported by grants from the Ministry of Health, Labour and Welfare, Japan (H30-Policy-Designated-004 and H29-ICT-General-004) and the Ministry of Education, Culture, Sports, Science and Technology, Japan (17H04141).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Clinical Epidemiology and Health Economics, School of Public HealthThe University of TokyoTokyoJapan
  2. 2.Department of Otolaryngology and Head and Neck Surgery, Faculty of MedicineThe University of TokyoTokyoJapan
  3. 3.Department of Health Policy and Informatics, Graduate School of MedicineTokyo Medical and Dental UniversityTokyoJapan

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