Topical Tranexamic acid may not be useful in Nasal bleeds, f
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Topical tranexamic acid is not effective in controlling bleeding and reducing the need for anterior packing in patients with atraumatic epistaxis that is uncontrolled with simple first-aid measures, finds a recent study.

Epistaxis is a common emergency department (ED) presentation and, if simple first aid measures fail, can lead to a need for anterior nasal packing. The aim of this study published by the Annals of the Emergency Medicine is to investigate the effectiveness of topical intranasal tranexamic acid in adult patients with persistent epistaxis, and whether it reduces the need for anterior nasal packing.

A double-blind, placebo-controlled, multicenter, 1:1, randomized controlled trial was conducted across 26 EDs in the United Kingdom. Participants with spontaneous epistaxis, persisting after simple first aid and the application of a topical vasoconstrictor, were randomly allocated to receive topical tranexamic acid or placebo. The primary outcome was the need for anterior nasal packing of any kind during the index ED attendance. Secondary outcome measures included hospital admission, need for blood transfusion, recurrent epistaxis, and any thrombotic events requiring any hospital reattendance within 1 week.

The study sample consisted of 496 participants with spontaneous epistaxis, persisting after simple first aid and application of a topical vasoconstrictor. In total, 211 participants received anterior nasal packing during the index ED attendance, including 111 of 254 in the tranexamic acid group versus 100 of 242 in the placebo group.

The difference was not statistically significant. Furthermore, there were no statistically significant differences between tranexamic acid and placebo for any of the secondary outcome measures.

Overall, in patients with atraumatic epistaxis that is uncontrolled with simple first-aid measures, topical tranexamic acid applied in the bleeding nostril on a cotton wool dental roll is no more effective than placebo at controlling bleeding and reducing the need for anterior nasal packing.

Source: https://doi.org/10.1016/j.annemergmed.2020.12.013
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