Topical Tranexamic Acid for the Treatment of Acute Epistaxis: A Systematic Review and Meta-analysis

Abstract

Objective: To compare topical tranexamic acid (TXA) with control groups for the treatment of acute epistaxis assessing bleeding cessation, discharge within 2 hours, rebleeding rates, complication rates, and patient satisfaction. Data Sources: PubMed, CINAHL, LILACS, Scopus, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched from inception to November 2018. Study Selection and Data Extraction: All randomized controlled trials comparing topical TXA with control groups for the treatment of acute epistaxis in humans were included. There were no age, language, or date restrictions. Data were double extracted into a predefined worksheet, and quality analysis was performed using the Cochrane Risk of Bias tool. Data Synthesis: Three studies (n = 408 patients) were identified. Topical TXA was not associated with a statistically significant difference in cessation of bleeding within 30 minutes. However, more patients were discharged within 2 hours of arrival, there were fewer episodes of rebleeding within both the first 24 hours and at 1 week, and there was higher patient satisfaction in the TXA group. There was no difference identified in complication rates. Relevance to Patient Care and Clinical Practice: This review compares topical TXA with control groups for epistaxis and discusses the risks and benefits of adding this therapy to usual care. Conclusions: Topical TXA appears to be a reasonable option for the treatment of acute epistaxis, with reduced rebleeding rates, shorter discharge times, and minimal risk of complications. Topical TXA may be considered as part of the treatment of acute epistaxis.

Tranexamic Acid for the Treatment of Epistaxis

“…While the studies utilized different search strategies, both were informed by similar studies in their reviews. The current review further supports the potential value of this intervention …”

“…Another recent systematic review of topical TXA in epistaxis identified faster discharge rates, reduced rebleeding at 24 hours, and greater patient satisfaction with TXA, but no difference in rebleeding at 30 minutes . While the studies utilized different search strategies, both were informed by similar studies in their reviews.…”

Evaluating Effectiveness of Nasal Compression With Tranexamic Acid Compared With Simple Nasal Compression and Merocel Packing: A Randomized Controlled Trial

“…Another important goal is to determine the optimal dosage of tranexamic acid in treatment of anterior epistaxis. Recently, a systematic review was published by Gottlieb et al 16 Although it has been reported that pledgets soaked in 5 mL (500 mg) of tranexamic acid were used in most studies, a different dosage of tranexamic acid was used in other studies. 12,13 Overall, we believe that to define optimal dosage and the optimal method of using topical tranexamic acid, novel studies conducted with a standardized dosage regimen and method are required.…”

Ambulatory management of common ENT emergencies – what's the evidence?

“…16 Use of topical tranexamic acid has been shown to reduce length of stay in emergency departments and decrease re-presentation rates, and it gives higher patient satisfaction rates than standard care. [25][26][27] Support for systemic tranexamic acid in epistaxis cases is more equivocal, but there is some evidence to support its use in select cases to reduce re-bleeding rates (e.g. in haemorrhagic telangiectasia), and there is no convincing evidence of adverse events when used for epistaxis.…”