Zahed R, et al. - This study was performed to ascertain the efficacy of topical application of the injectable form of tranexamic acid (TXA) compared with anterior nasal packing (ANP) for the treatment of epistaxis in patients taking antiplatelet drugs (Aspirin, Clopidegrol or both) who presented to the Emergency Department (ED). In this study, epistaxis treatment with topical application of TXA led to faster bleeding cessation, less re-bleeding at 1week, shorter ED length of stay (LOS), and higher patient satisfaction as compared with ANP.

Methods

• Researchers performed a randomized, parallel group clinical trial at 2 EDs.
• They randomized 124 participants to receive topical TXA (500 mg in 5 ml) or ANP, 62 patients per group.
• They primarily assessed the proportion of patients in each group whose bleeding had stopped at 10 minutes.
• The re-bleeding rate at 24 hours and one week, ED LOS, and patient satisfaction were assessed as secondary outcomes .

Results

• Bleeding was stopped in 73% of the patients in the TXA group within 10 minutes of treatment, compared with 29% in the ANP group (difference 44%, 95% confidence interval, 26%-57%; p < .001).
• Furthermore, researchers observed re-bleeding in 5% and 10% of patients during the first 24 hours in the TXA and the ANP groups, respectively.
• In the TXA group, 5% of patients and in the ANP group, 21% of patients had experienced recurrent bleeding (p=.007) at 1 week.
• Higher satisfaction scores were evident among the patients in the TXA group [(median (IQR), 9 (8-9.25)] compared with the anterior nasal packing group [median (IQR), 4 (3-5)] (p<.001).
• In the TXA group, 97% of patients were discharge from the ED in <2 hours vs 13% in the ANP group (p<.001).
• They noticed no adverse events in either group.