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.
from the UK randomized 496 patients with epistaxis (after failure of nasal
compression and topical vasoconstrictor) to topical tranexamic acid or
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.
outcome was the need for anterior nasal packing.
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%.
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
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.
TXA will work better in a different population.
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.
TXA for the Weet Bix? Hmmmm….
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