TXA for Epistaxis
Dr. Sophia Bodnar
It’s a busy ER shift. Everyone seems pretty sick today. You get a patient into a back room of your emergency department with a pretty bad nosebleed. The patient is a relatively young, healthy guy, first time bleeder, or at least this is the first nosebleed he has ever had to seek medical attention for. He is not on anticoagulation or antiplatelet therapy. His only risk factor is that he gets his nose hairs waxed (ew, why?!). This gentleman has been bleeding from his left nare for about two hours prior to coming to the emergency room and he couldn’t control the bleeding with pressure alone. Vital signs are stable, and he doesn’t have any other complaints such as dizziness, nausea, or headache. What is your approach?
Why is epistaxis relevant, besides the fact that everyone loves Eleven from Stranger Things? Epistaxis is a very common ED complaint, with over 450,000 visits a year and a lifetime incidence of 60%. Six percent will require medical attention, so you’re bound to see it frequently. Ideally, you want to stop this nosebleed in a quick, but also comfortable, manner for the patient.
Is there any recent evidence backing up using tranexamic acid (TXA) for anterior epistaxis?
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]
Obviously this is a clinically relevant topic with impressive results.
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.