The Use of Tranexamic Acid to Reduce the Need for Nasal Packing in Epistaxis (NoPAC): Randomized Controlled Trial

Reuben, Adam; Appelboam, Andrew; Stevens, Kara; Vickery, Jane; Ewings, Paul; Ingram, Wendy; Jeffery, Alison; Body, Richard; Hilton, Malcolm P; Coppell, Jason; Wainman, Brian; Barton, Andy

doi:10.1016/j.annemergmed.2020.12.013

Cited by 14 publications

(11 citation statements)

References 22 publications

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“…The results conflict with the NoPAC trial from 2021,3 4 which showed no difference in the need for nasal packing between TXA and placebo in 26 UK general EDs. However, NoPAC patients were first treated with local pressure, then topical vasoconstrictors (phenylephrine); TXA was given if bleeding continued.…”

Section: Intranasal Topical Application Of Tranexamic Acid In Atrauma...contrasting

confidence: 70%

Journal update monthly top five

et al. 2022

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Word count including subheadings & bottom line (excluding references): 1485This month's update is by the EMJ journal update monthly top five core team. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper.The papers are ranked as: Worth a peek-interesting, but not yet ready for prime time. Head turner-new concepts. Game changer-this paper could/should change practice.

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Section: Intranasal Topical Application Of Tranexamic Acid In Atrauma...contrasting

confidence: 70%

Journal update monthly top five

et al. 2022

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“…Figure 1 shows a flowchart of the study selection process. Twenty RCTs [9][10][11][12][13][14][15][16][17][18][35][36][37][38][39][40][41][42][43][44] met the inclusion criteria, constituting a total of 2994 patients. Some treatments only differ slightly, so they are considered a single group of treatments during the data synthesis and analysis.…”

Section: Study Selection and Characteristics Of Included Studiesmentioning

confidence: 99%

“…In summary, 12 different treatments were investigated among the 20 RCTs (Table 2). TXA (topical TXA; 11 RCTs), [9][10][11][12]14,17,35,39,41,43,44 TNP ( 11RCTs) , [11][12][13][14]16,[38][39][40][42][43][44] and control treatment (six RCTs) [9][10][11]17,37,41 were the most frequently investigated approaches to management.…”

Section: Study Selection and Characteristics Of Included Studiesmentioning

confidence: 99%

“…36,38,40,41 Seventeen studies were conducted in EDs, [9][10][11][12][13][14][15][16][17][18][38][39][40][41][42][43][44] while the remaining three were conducted in otolaryngology (ENT) clinics. [35][36][37] Fifteen studies exclusively included patients with anterior epistaxis, 9,[11][12][13][14][15][16][17][18]37,39,[41][42][43][44] two studies included both anterior and posterior epistaxis, 10,35 and three studies did not explicitly define the location of epistaxis. 36,38,40 Most studies excluded patients with trauma and coagulopathy.…”

Section: Study Selection and Characteristics Of Included Studiesmentioning

confidence: 99%

“…However, evidence for the effectiveness of topical TXA in preventing rebleeding was limited because only one randomized controlled trial (RCT) was included in that review. 8 Afterward, a number of RCTs comparing topical TXA to first-line conservative treatment [9][10][11] or traditional anterior nasal packing (TNP) [12][13][14][15] have been conducted. Commercial hemostatic agents or nasal packing materials have also been investigated as alternative initial treatments for epistaxis in emergency care, including Traumastem powder (Bioster, a.s.), 13 Celox coagulation powder and tampon (Medtrade Products Ltd.), 16 Merocel nasal pack (Medtronic Xomed, Inc.) (Merocel), 17 Rapid Rhino tamponade device (Applied Therapeutics, Inc.) (Rapid Rhino), and Rhino Rocket nasal pack (Shippert Medical Technologies, Rhino Rocket).…”

Section: Introduction Backgroundmentioning

confidence: 99%

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Comparative effectiveness of various noninvasive local treatments in patients with epistaxis: A systematic review and network meta‐analysis

Chiang

Lin

Tsai

et al. 2023

Academic Emergency Medicine

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BackgroundThe best initial strategy for managing epistaxis is unclear. We performed a systematic review and network meta‐analysis (NMA) to compare the effectiveness of various noninvasive treatments for patients with epistaxis.MethodsWe searched PubMed, Embase, and the Cochrane Library from inception to September 2022 without language restrictions. Randomized controlled trials (RCTs) assessing immediate hemostasis, 2‐day and 7‐day rebleeding outcomes, as well as the use of noninvasive interventions for the treatment of epistaxis were selected. Frequentist NMA was performed.ResultsThe systematic review included 20 RCTs (2994 participants) involving 12 different interventions. The NMA demonstrated that topical treatment with tranexamic acid (TXA) significantly reduced the odds of 2‐day rebleeding compared with the control conservative treatment (odds ratio [OR] 0.36, 95% confidence interval [CI] 0.21–0.61) and traditional anterior nasal packing (OR 0.45, 95% CI 0.26–0.76). The sensitivity analysis yielded robust results, and the overall evidence was high. Topical TXA significantly reduced the odds of 7‐day rebleeding compared with traditional nasal packing (OR 0.33, 95% CI 0.15–0.70), with moderate evidence owing to the heterogeneous results. Despite the significant effects of topical TXA on achieving immediate hemostasis and Rapid Rhino nasal packing on preventing 2‐day rebleeding compared to the control and traditional nasal packing, the evidence is low to very low due to heterogeneity, inconsistency, and within‐study bias.ConclusionsIn the treatment of epistaxis, topical TXA may be superior to conservative treatment or traditional nasal packing, particularly in preventing 2‐day rebleeding.

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