Topical Tranexamic Acid Compared With Anterior Nasal Packing for Treatment of Epistaxis in Patients Taking Antiplatelet Drugs: Randomized Controlled Trial

Abstract

In our study population, epistaxis treatment with topical application of TXA resulted in faster bleeding cessation, less rebleeding at 1 week, shorter ED LOS, and higher patient satisfaction compared with ANP.

Topical Tranexamic Acid for Epistaxis in Patients on Antiplatelet Drugs: A New Use for an Old Drug

“…Achieving hemostasis in these cases can be challenging for the very best emergency physician and a miserable experience for the most stoic of patients. In this issue of Academic Emergency Medicine, Zahed et al present findings from a randomized controlled trial comparing topical tranexamic acid (TXA) to anterior nasal packing (ANP) for treatment of anterior epistaxis in emergency department (ED) patients taking aspirin, clopidogrel, or both. This study expands on the authors' previous work demonstrating the benefit of topical TXA treatment for idiopathic epistaxis, and provides evidence for another tool we can use when faced with this vexing clinical scenario …”

Topical use of tranexamic acid for the management of post-procedural rectal bleeding

“…In the ED, topical TXA has primarily been used for cases of epistaxis [7]. There is a newly emerging body of ED literature that has found successful use of TXA in trials for treatment of epistaxis [8,9] and urinary tract bleeding [10].…”

Tranexamic Acid for the Treatment of Epistaxis

“…For the primary outcome ( n = 225 patients), TXA was associated with lower rates of rebleeding at 10 days (47% vs. 67%; relative risk [RR] = 0.71, 95% confidence interval = 0.56 to 0.90; absolute risk difference = 20%; number needed to treat = 5; moderate‐quality evidence) compared to placebo. There were no significant differences between groups for adverse events, although only five of the trials reported adverse events . The included trials did not report outcomes requiring further intervention (e.g.…”

“…Among the six trials ( n = 692 patients), two studies used oral TXA, while the remaining four used topical TXA . For the primary outcome ( n = 225 patients), TXA was associated with lower rates of rebleeding at 10 days (47% vs. 67%; relative risk [RR] = 0.71, 95% confidence interval = 0.56 to 0.90; absolute risk difference = 20%; number needed to treat = 5; moderate‐quality evidence) compared to placebo.…”