TXA for Epistaxis

Dr. Sophia Bodnar



Is there any recent evidence backing up using tranexamic acid (TXA) for anterior epistaxis?

Moreover, is there evidence for use of TXA in patients on antiplatelet therapy?


Zahed R, Mousavi Jazayeri MH, Naderi A, Naderpour Z, Saeedi M. Topical tranexamic acid compared with anterior nasal packing for treatment of epistaxis in patients taking antiplatelet drugs: randomized control trial. Academic Emergency Medicine. 2018;25(3):261-266. [paper] 

Multi-center (2 academic teaching hospital EDs in Tehran, Iran), prospective, randomized, non-blinded, parallel group trial.

Ultimately, the researchers enrolled 124 patients and grouped them in control (n=62) and intervention (n=62) groups with no patients lost to follow up. Overall, the patients had very similar characteristics in the two groups. In both groups, a majority of patients were on aspirin alone. There was a higher history of prior epistaxis in the intervention group.

Study Design



Patients on antiplatelet therapy can be treated with topical TXA for anterior epistaxis with improved cessation of bleeding and patient satisfaction. Number needed to treat of 2!




When dealing with anterior epistaxis I will definitely consider using topical TXA to stop the bleeding. It will get my patients discharged home sooner without invasive packing strategies. TXA is also typically readily available and inexpensive. While this is just one randomized control trial, it does support adopting this practice in patients on antiplatelet drugs.

By the way, with the patient from before, you ultimately used TXA to control the bleeding and the patient was discharged from the emergency room quickly without an anterior nasal packing. He vowed that he would never get his nose hairs waxed again.

Future Application