TXA: Potentially Useful Adjunct in the Management of Anterior Epistaxis

Clinical Question

Is topical tranexamic acid (TXA) effective in treating epistaxis?

Bottom Line

Current literature suggests that topical TXA could potentially be a useful adjunct in the management of anterior epistaxis.

Background: Epistaxis is a common emergency department (ED) presentation. Methods to manage epistaxis range from nasal compression to surgery. Nasal packing is generally effective but also associated with complications. Tranexamic acid, an antifibrinolytic agent commonly used in the operating room to reduce bleeding, has gained popularity as a treatment for epistaxis.

Study design: Literature study

Setting: Division of Otolaryngology–Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada

Synopsis: Researchers analyzed four prospective studies and one systematic review on the use of TXA to treat epistaxis. One study compared topical TXA to phenylephrine–lidocaine anterior nasal packing in 100 patients presenting with anterior epistaxis who take aspirin or clopidogrel. Both the mean time to resolution of epistaxis and recurrent bleeding were significantly lower in the TXA group. Another study evaluated the need for anterior packing in 240 patients referred to the ENT ED with spontaneous anterior epistaxis. The patients in the intervention group receiving TXA were less likely to require anterior nasal packing and spent less time in the ED. In this systematic review comprising eight studies and encompassing 1,299 patients, the authors concluded that TXA was more likely to achieve bleeding cessation at “first reassessment” than the control group. Of the remaining two studies, one found compression with TXA to be as effective as Merocel packing and the other saw no significant difference in need for anterior packing between TXA and placebo. Authors note that while their review suggests the potential usefulness of topical TXA as an adjunct to the treatment of anterior epistaxis, they identified multiple limitations in the analyzed literature.

Citation: Munroe KM, et al. In Response to: Is Topical Tranexamic Acid Effective in Treating Epistaxis. Laryngoscope. doi:10.1002/lary.32144.

Comment: This article looked at four randomized controlled trials and one systematic review/meta-analysis to evaluate the effectiveness of this treatment option. The study did suggest that topical TXA could be used as an adjunct in the management of anterior epistaxis. This is great, as it gives us a non-invasive, safe option to treat epistaxis, especially in children, before escalating to the need for packing or surgical intervention. Ryan Belcher, MD