Evaluating Effectiveness of Nasal Compression With Tranexamic Acid Compared With Simple Nasal Compression and Merocel Packing: A Randomized Controlled Trial

Abstract

Study objective: The primary objective of this study is to compare the effectiveness of 3 treatment protocols to stop anterior epistaxis: classic compression, nasal packing, and local application of tranexamic acid. It also aims to determine the frequency of rebleeding after each of these protocols.Methods: This single-center, prospective, randomized controlled study was conducted with patients who had spontaneous anterior epistaxis. The study compared the effect of 3 treatment options, tranexamic acid with compression but without nasal packing, nasal packing (Merocel), and simple nasal external compression, on the primary outcome of stopping anterior epistaxis bleeding within 15 minutes.Results: Among the 135 patients enrolled, the median age was 60 years (interquartile range 25% to 75%: 48 to 72 years) and 70 patients (51.9%) were women. The success rate in the compression with tranexamic acid group was 91.1% (41 of 45 patients); in the nasal packing group, 93.3% (42 of 45 patients); and in the compression with saline solution group, 71.1% (32 of 45 patients). There was an overall statistically significant difference among the 3 treatment groups but no significant difference in pairwise comparison between the compression with tranexamic acid and nasal packing groups. In regard to no rebleeding within 24 hours, the study found rates of 86.7% in the tranexamic acid group, 74% in the nasal packing group, and 60% in the compression with saline solution group. Conclusion:Applying external compression after administering tranexamic acid through the nostrils by atomizer stops bleeding as effectively as anterior nasal packing using Merocel. In addition, the tranexamic acid approach is superior to Merocel in terms of decreasing rebleeding rates. [

Dissolvable intranasal haemostatic agents for acute epistaxis: A systematic review and meta‐analysis

“…Vaiman et al 10 included patients with epistaxis due to any cause while in the remaining RCTs only patients with primary spontaneous epistaxis were eligible for inclusion. Two studies excluded patients on anticoagulation therapy (although not antiplatelet) 19,20 . A study by Mathiasen et al 22 excluded patients with international normalised ratio (INR) over 4.…”

“…Four RCTs with a total of 269 patients were eligible for inclusion and meta-analysis (Table 3). 10,[19][20][21] Two studies compared FLOSEAL ® with nasal packs, 20,21 only patients with primary spontaneous epistaxis were eligible for inclusion. Two studies excluded patients on anticoagulation therapy (although not antiplatelet).…”

Tranexamic acid for the prevention and treatment of bleeding in surgery, trauma and bleeding disorders: a narrative review

“…TXA is also used for idiopathic epistaxis in inpatients or outpatients visiting the emergency department, especially in patients taking antithrombotic drugs. Moderate evidence has shown that topical TXA significantly reduced the duration of epistaxis and the risk of rebleeding (within 10 days) compared to nasal packing [16][17][18]. For the treatment of epistaxis, TXA can be applied via TXA-soaked cotton pledgets or sprayed, followed by external compression for 15 min (Table 1) [16][17][18].…”

Thrombostatic Agents and Tissue Adhesives in the Emergency Department: Stopping the Bleeding, Closing the Wound, and Novel Applications

“…Donald Jeanmonod, Guhan Rammohan and Rebecca Jeanmonod* Department of Emergency Medicine, St. Luke's University Hospital, Bethlehem, PA, USA *Address all correspondence to: rebeccajeanmonod@yahoo.com an atomizer and/or saturating nasal tampons with topical application of 500 mg of the IV formulation (TXA 100 mg/ml). Care must be taken in patients with higher risk of systemic thrombosis as systemic absorption may be variable when TXA is applied to the nasal mucosa [63].…”