Epistaxis and Tranexamic acid

A new and rapid method for epistaxis treatment using injectable form of tranexamic acid topically: a randomized controlled trial.

Author: Zahed R, Moharamzadeh P, Alizadeharasi S, Ghasemi A, Saeedi M.

Reference: Am J Emerg Med. 2013 Sep;31(9):1389-92. doi: 10.1016/j.ajem.2013.06.043. Epub 2013 Jul 30.

Summary: This randomised controlled trial compared tranexamic acid with anterior nasal packing for patients with anterior epistaxis presenting to ED. 216 subjects with epistaxis were randomised to the injectable form of tranexamic acid (500 mg in 5 ml) applied topically, or anterior nasal packing with pledgets coated with tetracycline ointment. Outcome measures were time to cessation of bleeding, length of hospital stay (hours), and re-bleeding rates at 24 hours and 1 week. Patient satisfaction with treatment was rated on a 1-10 scale. Tranexamic acid was superior to anterior nasal packing for arresting bleeding at 10 minutes; 71 vs. 31.2% respectively (OR 2.28, 95% CI 1.68-3.09, p < 0.001) and discharge within 2 hours; 95.3 vs. 6.4% (p < 0.001). No difference was observed in between-group rates of re-bleeding at 24 hours; 4.7 vs. 11% (p = 0.128). Patient satisfaction with treatment was significantly greater for tranexamic acid compared to anterior nasal packing; 8.5 vs. 4.4 (p < 0.001).

Comment: The study showed good results, control of bleeding within 10 mins (71%) and discharged within 2hours(95%). More studies required for confirmation.

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