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Tranexamic acid (TXA) has been investigated for reducing bleeding in head and neck (H&N) surgery, but the results are variable. This systematic review of 16 studies involving 114,407 patients aimed to determine the safety and efficacy of TXA use in H&N surgery. TXA was found to be effective in reducing intraoperative blood loss in tonsillectomy, but the effect on posttonsillectomy hemorrhage was unclear. Insufficient evidence exists of the benefit of TXA on intraoperative bleeding in major H&N procedures. Postoperative drainage volumes were significantly reduced in most major H&N studies, but the duration of drain placement and risk of blood transfusion remained unchanged in most cases.
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