What is the Best Management for Geriatric Epistaxis? A Comprehensive Systematic Review and Meta-analysis

Abstract

Background: Given the importance of epistaxis in elder patients, this systematic review was conducted to determine the best non-surgical treatment of epistaxis in elder patients. Methods: A systematic search of references was performed to investigate non-surgical methods in administering epistaxis in elder people in March 2022 for relevant articles. Results: Among 1613 retrieved articles in the initial search, 28 studies were included, and the mean re-bleeding in 18 studies was 18%. Regarding the treatment methods, 35.7%, 14.3%, 10.7%, and 10.7% used nasal packing, intranasal topical tranexamic acid, silver nitrate, and Floseal® treatment, respectively. The highest success rate was related to topical tranexamic acid compared to topical oxymetazoline spray (Odds ratio [OR]: 6.50, 95% confidence interval [CI]: 1.54-27.49, P=0.011), followed by nasal compression with tranexamic acid compared to the placebo. Conclusion: It seems that tranexamic acid has a beneficial effect on controlling epistaxis in the elderly. However, well-designed large randomized controlled trials are indicated for an accurate conclusion.