Original ContributionA new and rapid method for epistaxis treatment using injectable form of tranexamic acid topically: a randomized controlled trial☆
Introduction
Epistaxis, a common condition in all age groups, has a bimodal distribution with 2 peaks: under the age of 10 years and in the 60s [1]. Sixty percent of people probably experience epistaxis once in their life [2]. Although epistaxis may occur secondary to surgery, trauma, hypertension, bleeding disorders, hereditary hemorrhagic telangiectasia, and antiplatelet and anticoagulation drug use, its etiology is unknown in 70% to 80% of cases [3]. Epistaxis is usually self-limiting but can be life threatening, especially in elder patients or those with underlying conditions [4].
Currently, treatment of epistaxis includes squeezing the nose, using vasoconstrictor agents, chemical (silver nitrate) or electrical cauterization, and nasal packing with ribbon gauze or nasal tampon [5]. Nasal packing is usually performed after application of an anesthetic agent such as lidocaine and a vasoconstrictor such as epinephrine [6]; this may cause mucosal shrinkage and ease of insertion of the pledgets covered with petroleum jelly or ointments such as tetracycline and inflatable balloon or packs [4]. Anterior nasal packing, as one of the most routine management for epistaxis, has some limitations including long stay of the pack, need for prophylactic antibiotics, and need for analgesics [4]; these warrant assessing a more simple method.
Several locally applied hemostatic agents including tranexamic acid [7] and aminocaproic acid [8] have been used for epistaxis treatment. Among them, tranexamic acid has been applied orally [9], topically [7], and as local gels [10]; however, systemic tranexamic acid is contraindicated in thromboembolic patients. The aim of this study was to determine the efficacy of the topical application of the injectable form of tranexamic acid in the treatment of epistaxis.
Section snippets
Study design
This study was a randomized, single-center, parallel group clinical trial, comparing treatment efficacy of local application of injectable form of tranexamic acid (500 mg in 5 mL) in the nasal cavity with that of usual anterior nasal packing. Postgraduate year 3 emergency medicine residents participated in a 2-hour workshop for unifying the ability and skill of the anterior nasal packing and introducing with the process we meant to do.
Setting and selection of participants
Patients of this study were randomly selected from those
Characteristics of study subjects
This randomized clinical trial study was conducted on 216 subjects (124 men and 92 women). Basic characteristics of the patients are presented in Table 1. Two groups were comparable regarding these variables except for epistaxis history, which was significantly higher in the tranexamic acid group.
Outcomes
Within 10 minutes of treatment, bleedings were arrested in 76 (71%) of 107 patients in the tranexamic acid group, compared with 34 (31.2%) of 109 patients in the anterior nasal packing group (odds
Discussion
Epistaxis treatments are divided into conservative and surgical treatments; in the former, in addition to the routine packing by gauze or cotton pledgets, there are some commercially available products such as Surgicel, Gelfoam, and Merocel.
The results of this trial showed that treating anterior epistaxis with the topical use of injectable form of tranexamic acid is better than usual nasal packing. In our study, nasal bleeding in ≈ 70% of patients in the tranexamic acid group was arrested within
Acknowledgment
The authors thank Ms Asieh Naderi, BSc of Nursing, PhD student of Physiology.
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The authors declare that there is no conflict of interest with this manuscript.