The Use of Tranexamic Acid to Reduce the Need for Nasal Packing in Epistaxis (NoPAC): RCT

We all know tranexamic acid (TXA) is good for everything. It’s great for trauma, all kinds of bleeding and heck, tastes great on Weet Bix. But a lot of this enthusiasm is now being challenged by hard science.

These researchers from the UK randomized 496 patients with epistaxis (after failure of nasal compression and topical vasoconstrictor) to topical tranexamic acid or placebo.

Trial treatment was with cotton wool dental roll either soaked in 200mg tranexamic acid or sterile water. The dental roll was left in for 10 minutes and could be repeated a second time if the bleeding continued.

The primary outcome was the need for anterior nasal packing.

Results?

The mean age was about 70 and two thirds were on anticoagulants.

In the end, the rates of anterior nasal packing were about the same in both groups at 40%.

The authors conclude the that tranexamic acid is no better than placebo.

But I’m not so sure this is going to change practice to those who are tranexamic acid afficionados.

The inclusion of mostly elderly patients on anticoagulants could have diluted the results to the null hypothesis. These are a hard group to treat and, in my experience, often get nasal packing. And remember, the patients enrolled in this study had already failed compression and vasoconstrictors.

So, perhaps TXA will work better in a different population.

Many would argue that TXA is cheap and very unlikely to cause harm. But so are bedside anti-epistaxis incantations. Either one of them is possibly a waste of time and distracting from performing other measures.

Perhaps save TXA for the Weet Bix? Hmmmm….

 

Covering

Reuben A, Appelboam A, Stevens K, et al. The Use of Tranexamic Acid to Reduce the Need for Nasal Pcking in Epistaxis (NoPAC): Randomized Controlled Trial. Ann Emerg Med. 2021 Feb 18;S0196-0644(20)31461-X [Link to article]