The current treatment for epistaxis consists of holding pressure, local vasoconstrictor, silver nitrate or anterior nasal packing. Recently, the use of topical TXA has been purposed. A previous study in 2013 showed that topical TXA resulted in shorter epistaxis control and shorter ED LOS in patients not on any anticoagulants or antiplatelets.
A new randomized control trial by the same authors investigated the use of topical TXA in patients on ASA, clopidogrel or both. This study showed that TXA resulted in faster bleeding cessation < 10 minutes (anterior packing 29% vs. topical TXA 73%), less re-bleeding in 1 week (anterior packing 21% vs. topical TXA 5%), ED LOS < 2 hrs (anterior packing 13% vs. topical TXA 97%), and higher patient satisfaction (anterior packing median 4 vs. topical TXA median 9).
Take home point: Topical TXA seems to be more effective than our standard anterior packing. However, further validation studies should be performed in different populations (ie. patients on different ACs).
Zahed R et al. A new and rapid method for epistaxis treatment using injectable form of tranexamic acid topically: a randomized controlled trial. Am J Emerg Med 2013; 31: 1389-92. PMID: 23911102
Zahed R et al. Topical Tranexamic Acid Compared With Anterior Nasal Packing for Treatment of Epistaxis in Patients Taking Antiplatelet Drugs: Randomized Controlled Trial. Acad Emerg Med 2017. PMID: 29125679