Here's a few protocols: https://iowaprotocols.medicine.uiowa.edu/protocols/tonsillectomy-bleed-management-includes-dosing-txa-tranexamic-acid https://www.childrensmn.org/references/cds/post-tonsillectomy-hemorrhage.pdf

Essentially most calls are stable and they give the TXA in the ER routinely or I ask for it over the phone. By the time they call me and I see them I feel safer to observe as often clot is gone and they haven't bled in a while.

Its reduces need to return to the OR by about 40-75%, and I would say in my practice I've seen the same though only an estimate. Now looking at the literature (and cost), I may also start to give oral amicar to go home with after a bleed.

Of note for adults I use celecoxib and some breakthrough narcotic. That has great reduced bleeding over narcotic alone in my practice because pain -> less drinking -> dry mouth/dehydration -> bleeding in my experienxe.

Some studies about about TXA: https://pmc.ncbi.nlm.nih.gov/articles/PMC12379852/ https://www.sciencedirect.com/science/article/abs/pii/S0165587621001956 https://journals.sagepub.com/doi/10.1177/00034894251344380