Tranexamic Acid for Patients with Nasal Haemorrhage (Epistaxis)

Summary

A Cochrane review [Abstract] 1 included 6 studies with a total of 692 adults. Two studies assessed oral administration of tranexamic acid, given regularly over several days, vs. placebo. In the other 4 studies, a single application of topical tranexamic acid was compared with placebo (one study) and a combination of epinephrine and lidocaine or phenylephrine (3 studies).

Tranexamic acid vs. placebo: The primary outcome was control of epistaxis: proportion re-bleeding within 10 days. The pooled result demonstrated a benefit of tranexamic acid vs. placebo, the risk of re-bleeding reducing from 67% to 47% (RR 0.71, 95% CI 0.56 to 0.90; 3 studies, n=225). When the effects of oral and topical tranexamic acid were compared separately, the risk of re-bleeding with oral tranexamic acid reduced from 69% to 49%, RR 0.73 (95% CI 0.55 to 0.96; 2 studies, n=157) and with topical tranexamic acid it reduced from 66% to 43%, RR 0.66 (95% CI 0.41 to 1.05; one study, n=68). There was no difference in time to stop initial bleeding (proportion with bleeding controlled within 30 minutes) using topical tranexamic acid (RR 0.79, 95% CI 0.56 to 1.11; one study, n=68). There was no difference between groups in the proportion of patients requiring blood transfusion using oral tranexamic acid: 5/45 (11%) vs. 6/44 (14%) (RR 0.81, 95% CI 0.27 to 2.48; one study, n=89). One study (n=68) reported a significantly shorter stayat hospital in the oral tranexamic acid group (MD 1.60 days, 95% CI 2.49 to 0.71). The other study found no difference between the groups.

Tranexamic acid vs. other haemostatic agents: The proportion of patients whose bleeding stopped within 10 minutes was significantly higher in the topical tranexamic acid group vs. the group receiving another haemostatic agent (70% versus 30%: RR 2.35, 95% CI 1.90 to 2.92; 3 studies, n=460).