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Tranexamic acid, as a WHO 'essential medicine', is a powerful, readily available tool, the use of which in epistaxis has been limited by uncertainty over its efficacy and its safety profile. This systematic review summarises the existing evidence and extrapolates from the wealth of data for other specialties to address the clinical question - does TXA have a role in epistaxis management?

Low-level evidence suggests salivary bypass tubes may reduce the incidence of fistula in high-risk patient groups. A robust randomised controlled trial, or large, multicentre cohort studies, are needed to further examine this intervention.

Introduction: Recent studies have reported that elevated levels of platelets and inflammatory markers are associated with poor treatment outcomes among patients with solid tumours, but reports are conflicting in head and neck cancer (HNC) patients. Objective: To establish if pre-treatment anti-inflammatory markers can be used as a prognostic tool of overall survival and tumour control among HNC patients. Methods: We retrospectively reviewed the pre-treatment platelet/lymphocyte ratio (PLR) and neutrophil/lymphocyte ratio (NLR) of 147 HNC patients from 2014 to 2018 and analysed their association with tumour progression and overall treatment outcomes. The optimal cutoff was established at > 200 for high PLR and > 2.85 for high NLR. Results: After adjusting for age, disease stage, and treatment, patients with higher PLR had an almost 3 times higher risk of mortality during the study period than patients with normal PLR (hazard ratio [HR] 2.79, 95% confidence interval [CI] 1.43-5.47, p < 0.01). Furthermore, the patients with higher NLR had an > 2.5 times higher risk of mortality than those with normal NLR (HR 2.62, 95% CI 1.19-5.81, p = 0.02). Conclusion: This observational study shows that elevated PLR and NLR in HNC patients, who were treated with either surgery or primarily chemoradiotherapy, are associated with poor overall survival.

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