Tranexamic acid administration practice in otolaryngology head & neck surgery; international survey

Ron Eliashar, Seth M. Cohen, Nir Hirshoren*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Purpose: Tranexamic acid (TXA) is a potent pro-coagulation drug. Pre-operative, preventive TXA administration and TXA use for active bleeding are established treatments in many medical situations; yet, less is known about its use in otolaryngology head and neck surgery practice. The primary study goals were: 1. Evaluate physician practice, patients profile, and TXA administration indications. 2. Characterize practice differences between academic and non-academic physicians and between two countries. Materials and methods: This is an international survey exploring TXA administration strategy. The electronic, anonymous, questionnaire was emailed to all registered Israeli and American Otolaryngology Head and Neck Surgery (OHNS) physicians, investigating TXA administration: 1. Patient age and comorbidities 2. Active bleeding indications 3. Preventive bleeding indications in common operations in otolaryngology. Results: Overall, 317 otolaryngologists participated in the study. TXA was administered to 40.5 % of the pediatric population and 50 % of the adult patients when needed. Epistaxis was the most common indication for TXA administration (48–55 %). A small number of otolaryngologists, 4–13 %, recommended preventive TXA for various operations. More surgeons include TXA in their practice and adjusted the dose according to renal function in academic compared to non-academic medical centers and among otolaryngologists practicing in Israel compared to the United States. Conclusions: TXA is provided by many otolaryngologists to treat active epistaxis but to a substantially lesser extent as a preventive measure. TXA is given to children and adults, some with substantial comorbidities. Treatment is more common among surgeons working in academic institutes and medical centers in Israel.

Original languageAmerican English
Article number103590
JournalAmerican Journal of Otolaryngology - Head and Neck Medicine and Surgery
Issue number5
StatePublished - 1 Sep 2022
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2022 Elsevier Inc.


  • Academic hospitals
  • Otolaryngology head and neck surgery
  • Preventative treatment
  • Survey
  • Tranexamic acid


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