Topical Tranexamic acid may not help reduce nosebleeds or need for nasal packing: Study
UK: Topical tranexamic acid is not effective in controlling bleeding and reducing the need for anterior nasal packing in patients with atraumatic epistaxis that is uncontrolled with simple first aid measures, finds a recent study. The findings of the study are published in the journal Annals of Internal Emergency Medicine.
Epistaxis or nosebleed is common emergency department (ED) presentation. In most of the cases, it can be controlled by simple first aid measures but if those measures fail, anterior nasal packing is required. Tranexamic acid is an agent that contributes to blood clot stability. Adam Reuben, Royal Devon and Exeter NHS Foundation Trust, Exeter, England, and colleagues aimed to investigate the effectiveness of topical intranasal tranexamic acid in adult patients presenting to the ED with persistent epistaxis, and whether it reduces the need for anterior nasal packing.
For the purpose, the researchers performed a double-blind, placebo-controlled, multicenter 1:1, randomized controlled trial from May 5, 2017, to March 31, 2019 across 26 EDs in the United Kingdom.
It included 496 participants with spontaneous epistaxis, persisting after simple first aid and application of a topical vasoconstrictor. They were randomly allocated to receive topical tranexamic acid or placebo.
The primary outcome was the need for anterior nasal packing of any kind during the index ED attendance. Secondary outcome measures included hospital admission, need for blood transfusion, recurrent epistaxis, and any thrombotic events requiring any hospital reattendance within 1 week.
Key findings of the study include:
- In total, 211 participants (42.5%) received anterior nasal packing during the index ED attendance, including 111 of 254 (43.7%) in the tranexamic acid group versus 100 of 242 (41.3%) in the placebo group.
- The difference was not statistically significant (odds ratio 1.107).
- There were no statistically significant differences between tranexamic acid and placebo for any of the secondary outcome measures.
"In patients presenting to an ED with atraumatic epistaxis that is uncontrolled with simple first aid measures, topical tranexamic acid applied in the bleeding nostril on a cotton wool dental roll is no more effective than placebo at controlling bleeding and reducing the need for anterior nasal packing," wrote the authors.
The study titled, "The Use of Tranexamic Acid to Reduce the Need for Nasal Packing in Epistaxis (NoPAC): Randomized Controlled Trial," is published in the journal Annals of Internal Emergency Medicine.
DOI: https://www.sciencedirect.com/science/article/abs/pii/S019606442031461X
