Interest in tranexamic acid has re-emerged with the recent publication of the CRASH-3 study.1 This landmark study involving 12 737 patients demonstrated that tranexamic acid is safe in patients with traumatic brain injury, and treatment within 3 hours of injury reduces head injury related death. Within the field of ENT, tranexamic acid has primarily been studied in the management of tonsillectomy bleeding, epistaxis and functional endoscopic sinus surgery.Reference Robb2,Reference Williams, Biffen, Pilkington, Arrick, Williams and Smith3
In this month's issue of The Journal of Laryngology & Otology, two articles investigate whether there is a role for tranexamic acid in other settings, thereby potentially extending its applications within ENT. Thakur et al. investigate the effect of tranexamic acid (compared to saline placebo) on post-operative blood loss in various head and neck surgical procedures (including thyroid and parotid surgery, and neck dissections, with or without primary tumour excision) in a double-blinded, randomised, controlled trial involving 92 patients.Reference Thakur, Gupta, Thakur, Minhas, Azad and Vasanthalakshmi4 Although this prospective, randomised, placebo-controlled clinical trial found a reduction in post-operative drain volume in the tranexamic acid group, the difference was not statistically significant between the various head and neck surgical procedure groups. Despite confirming the null hypothesis, this is a useful study that supports previously published data in this patient group and confirms there does not appear to be a significant benefit of the use of tranexamic acid in this group of patients.Reference Chen, Wang, Wang, Lin, Lin and Liu5
Also in this month's issue, Das et al. assess whether tranexamic acid improves intra-operative visualisation in endoscopic ear surgery.Reference Das, Mitra, Ghosh, Kumar and Sengupta6 This randomised, controlled (comparing tranexamic acid to saline placebo) and double-blinded study found that tranexamic acid appears to be an effective haemostat in endoscopic ear surgery, thus improving surgical field visualisation, especially during manipulation of the external auditory canal soft tissues. With respect to the middle ear, no statistically significant difference was found between the two agents.
The Journal Senior Editors would like to take this opportunity to thank all those who have contributed to the success of this year's journal, including all the authors, Assistant Editors, reviewers, advisers, production staff, our publishing partners at Cambridge University Press and all other colleagues at The Journal. In particular, we would like to take this opportunity to thank Musheer Hussain, who leaves us at the end of this year, for his dedication, enthusiasm and hard work over the last few years as a Senior Editor for The Journal. Finally, we wish all of our readers a happy and successful 2020.
