Zahed R, et al. - The efficacy of topical application of the injectable form of tranexamic acid (TXA) was compared with the efficacy of anterior nasal packing (ANP) for the treatment of epistaxis in patients taking antiplatelet drugs (aspirin, clopidogrel, or both) who presented to the Emergency Department (ED). In the study population, topical application of TXA for epistaxis treatment resulted in faster bleeding cessation, less rebleeding at 1 week, shorter ED length of stay (LOS), and higher patient satisfaction compared with ANP.

Methods

• Researchers performed a randomized, parallel-group clinical trial at two EDs.
• They randomized a total of 124 participants to receive topical TXA (500 mg in 5 mL) or ANP, 62 patients per group.
• The proportion of patients in each group whose bleeding had stopped at 10 minutes was assessed as the primary outcome.
• The rebleeding rate at 24 hours and 1 week, ED length of stay (LOS), and patient satisfaction were included as the secondary outcomes.

Results

• In the TXA group, bleeding was stopped in 73% of the patients within 10 minutes of treatment, compared with 29% in the ANP group (difference = 44%, 95% confidence interval, 26% to 57%; p < 0.001).
• Furthermore, in the TXA and the ANP groups, 5% and 10% of patients reported rebleeding during the first 24 hours, respectively.
• Recurrent bleeding was reported in 5% of patients in the TXA group and 21% of patients in the ANP group at 1 week (p = 0.007).
• Higher satisfaction scores (median [interquartile range {IQR}], 9 [8–9.25]) were reported by patients in the TXA group than the ANP group (median [IQR] = 4 [3–5]; p < 0.001).
• In this study, 97% of patients in the TXA group vs 13% in the ANP group were discharge from the ED in <2 hours (p < 0.001).
• No adverse events were reported in either group.