Tranexamic acid and beyond: A systematic review of pediatric post-tonsillectomy hemorrhage protocols and introduction of a universal management guideline.

Through this systematic review, we identified 12 publicly available hospital post-tonsillectomy hemorrhage protocols, all developed at quaternary or near-quaternary centers.

Nebulized tranexamic acid was most consistently recommended for active bleeding, with intravenously tranexamic acid reserved for active or higher-volume bleeding.

Our guideline recommends nebulized tranexamic acid for all post-tonsillectomy hemorrhage patients, with intravenously tranexamic acid for all active bleeding and on a case by case basis for controlled bleeding.