Topical tranexamic acid for the treatment of acute epistaxis in the emergency department

Birmingham, Asha R.; Mah, Nathan D.; Ran, Ran; Hansen, Matthew

doi:10.1016/j.ajem.2018.03.039

Cited by 19 publications

(12 citation statements)

References 6 publications

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“…Additionally, a recent retrospective study found that the use of topical TXA may also result in lower rates of nasal packing and fewer otolaryngology consultations. 17…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, a recent retrospective study found that the use of topical TXA may also result in lower rates of nasal packing and fewer otolaryngology consultations. 17 One previous systematic review evaluated TXA for all forms of epistaxis and suggested that TXA may have a benefit for the treatment of epistaxis. 18 However, the prior review included both oral and topical administration as well as prophylactic TXA for patients at risk of bleeding, limiting the ability to combine the data for meta-analyses.…”

Section: Discussionmentioning

confidence: 99%

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Topical Tranexamic Acid for the Treatment of Acute Epistaxis: A Systematic Review and Meta-analysis

2018

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Objective: To compare topical tranexamic acid (TXA) with control groups for the treatment of acute epistaxis assessing bleeding cessation, discharge within 2 hours, rebleeding rates, complication rates, and patient satisfaction. Data Sources: PubMed, CINAHL, LILACS, Scopus, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched from inception to November 2018. Study Selection and Data Extraction: All randomized controlled trials comparing topical TXA with control groups for the treatment of acute epistaxis in humans were included. There were no age, language, or date restrictions. Data were double extracted into a predefined worksheet, and quality analysis was performed using the Cochrane Risk of Bias tool. Data Synthesis: Three studies (n = 408 patients) were identified. Topical TXA was not associated with a statistically significant difference in cessation of bleeding within 30 minutes. However, more patients were discharged within 2 hours of arrival, there were fewer episodes of rebleeding within both the first 24 hours and at 1 week, and there was higher patient satisfaction in the TXA group. There was no difference identified in complication rates. Relevance to Patient Care and Clinical Practice: This review compares topical TXA with control groups for epistaxis and discusses the risks and benefits of adding this therapy to usual care. Conclusions: Topical TXA appears to be a reasonable option for the treatment of acute epistaxis, with reduced rebleeding rates, shorter discharge times, and minimal risk of complications. Topical TXA may be considered as part of the treatment of acute epistaxis.

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“…Additionally, a recent retrospective study found that the use of topical TXA may also result in lower rates of nasal packing and fewer otolaryngology consultations. 17…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Topical Tranexamic Acid for the Treatment of Acute Epistaxis: A Systematic Review and Meta-analysis

2018

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“…It use is also reported in dental/ oral bleeding [5], and post-partum hemorrhage [6]. 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].…”

Section: Discussionmentioning

confidence: 99%

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

Altawil

Gendron

Schechter‐Perkins

2019

The American Journal of Emergency Medicine

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“…They found no reduction in length of stay among patients who received TXA but did identify a decrease in both nasal packing and otolaryngologic consultation following TXA. 45 A current, ongoing multicenter RCT enrolling 450 patients aims to further assess the effects of TXA on the rate of nasal packing for refractory epistaxis 46 (Table 2).…”

Section: Anterior Epistaxismentioning

confidence: 99%

The Role of Tranexamic Acid in the Management of an Acutely Hemorrhaging Patient

et al. 2020

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Background: Acute hemorrhage, both traumatic and nontraumatic, leads to significant morbidity and mortality, both in the United States and globally. Traditional treatment of acute hemorrhage is focused on hemostasis and blood product replacement. Tranexamic acid is an antifibrinolytic agent that may reduce acute hemorrhage through inhibition of plasminogen. Newer research suggests that coagulopathy, specifically fibrinolysis, may contribute significantly to the pathology of acute hemorrhage. Methods: We searched the PubMed database for relevant articles from 2000 to 2018 for the terms “tranexamic acid,” “TXA,” “antifibrinolytic,” “hyperfibrinolysis,” and “coagulopathy.” Our search was limited to studies published in the English language. Results: A total of 53 studies were included in this review. These articles suggest a potential role for tranexamic acid in the management of acute intracranial hemorrhage, epistaxis, hematuria, postpartum hemorrhage, gastrointestinal hemorrhage, and trauma-related hemorrhage. A theoretical risk of thrombotic events following tranexamic acid use exists, though large clinical trials suggest this risk remains exceedingly small. Conclusions: Recent studies suggest a mortality benefit with tranexamic acid following acute hemorrhage. First responders such as emergency medical technicians and emergency department clinicians should consider tranexamic acid as an adjunct therapy in the management of acute, severe traumatic and nontraumatic hemorrhage.

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Topical tranexamic acid for the treatment of acute epistaxis in the emergency department

Cited by 19 publications

References 6 publications

Topical Tranexamic Acid for the Treatment of Acute Epistaxis: A Systematic Review and Meta-analysis

Topical Tranexamic Acid for the Treatment of Acute Epistaxis: A Systematic Review and Meta-analysis

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

The Role of Tranexamic Acid in the Management of an Acutely Hemorrhaging Patient

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