Topical Tranexamic Acid Compared With Anterior Nasal Packing for Treatment of Epistaxis in Patients Taking Antiplatelet Drugs: Randomized Controlled Trial

Abstract

Objective

We evaluated 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).

Methods

A randomized, parallel group clinical trial was conducted at 2 EDs. A total of 124 participants were randomized to receive topical TXA (500 mg in 5 ml) or ANP, 62 patients per group. The primary outcome was the proportion of patients in each group whose bleeding had stopped at 10 minutes. Secondary outcomes were the re-bleeding rate at 24 hours and one week, ED length of stay (LOS), and patient satisfaction.

Results

Within 10 minutes of treatment, bleeding was stopped in 73% of the patients in the TXAgroup, compared with 29% in the ANP group (difference 44%, 95% confidence interval, 26%-57%; p<.001). Additionally, re-bleeding was reported in 5% and 10% of patients during the first 24 hours in the TXA and the ANP groups, respectively. At 1 week, 5% of patients in the TXA group and 21% of patients in the ANP group had experienced recurrent bleeding (p=.007). Patients in the TXA group reported higher satisfaction scores [(median (IQR), 9 (8-9.25)] compared with the anterior nasal packing group [median (IQR), 4 (3-5)] (p<.001). Discharge from the ED in <2 hours was achieved in 97% of patients in the TXA group vs. 13% in the ANP group (p<.001). There were no adverse events reported in either group.

Conclusions

In our study population, epistaxis treatment with topical application of TXA resulted in faster bleeding cessation, less re-bleeding at 1week, shorter ED LOS, and higher patient satisfaction as compared with ANP.

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