In this episode, I’ll discuss whether tranexamic acid reduces the need for nasal packing in epistaxis.
Epistaxis in ED patients is first treated with topical measures, usually a vasoconstrictor, and if unsuccessful treatment progresses to anterior packing. Anterior packing has risks including toxic shock syndrome and the inconvenience of needing another visit or appointment to remove the packing days later.
Topical application of tranexamic acid is hoped to reduce the need for anterior packing.
Researchers recently published in Annals of Emergency Medicine a randomized placebo-controlled trial to assess the effectiveness of tranexamic acid in this setting.
Just under 500 patients with spontaneous epistaxis that persisted after simple first aid and the application of a topical vasoconstrictor were randomly allocated to receive topical tranexamic acid or placebo.
The need for anterior packing was no different between groups. There was also no difference in any of the secondary measures including hospital admission, need for blood transfusion, recurrent epistaxis, and any thrombotic events requiring any hospital reattendance within 1 week.
The results of this study show that tranexamic acid applied in this manner is a futile intervention with no clinical benefit.
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