EvidenceAlerts

Akkan S, Corbacioglu SK, Aytar H, et al. Evaluating Effectiveness of Nasal Compression With Tranexamic Acid Compared With Simple Nasal Compression and Merocel Packing: A Randomized Controlled Trial. Ann Emerg Med. 2019 Jul;74(1):72-78. doi: 10.1016/j.annemergmed.2019.03.030. Epub 2019 May 9. (Original study)
Abstract

STUDY OBJECTIVE: The primary objective of this study is to compare the effectiveness of 3 treatment protocols to stop anterior epistaxis: classic compression, nasal packing, and local application of tranexamic acid. It also aims to determine the frequency of rebleeding after each of these protocols.

METHODS: This single-center, prospective, randomized controlled study was conducted with patients who had spontaneous anterior epistaxis. The study compared the effect of 3 treatment options, tranexamic acid with compression but without nasal packing, nasal packing (Merocel), and simple nasal external compression, on the primary outcome of stopping anterior epistaxis bleeding within 15 minutes.

RESULTS: Among the 135 patients enrolled, the median age was 60 years (interquartile range 25% to 75%: 48 to 72 years) and 70 patients (51.9%) were women. The success rate in the compression with tranexamic acid group was 91.1% (41 of 45 patients); in the nasal packing group, 93.3% (42 of 45 patients); and in the compression with saline solution group, 71.1% (32 of 45 patients). There was an overall statistically significant difference among the 3 treatment groups but no significant difference in pairwise comparison between the compression with tranexamic acid and nasal packing groups. In regard to no rebleeding within 24 hours, the study found rates of 86.7% in the tranexamic acid group, 74% in the nasal packing group, and 60% in the compression with saline solution group.

CONCLUSION: Applying external compression after administering tranexamic acid through the nostrils by atomizer stops bleeding as effectively as anterior nasal packing using Merocel. In addition, the tranexamic acid approach is superior to Merocel in terms of decreasing rebleeding rates.


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Ratings
Discipline Area Score
Emergency Medicine 7 / 7
Hemostasis and Thrombosis 6 / 7
Family Medicine (FM)/General Practice (GP) 6 / 7
General Internal Medicine-Primary Care(US) 6 / 7
Surgery - Ear Nose Throat 5 / 7
Comments from MORE raters

Emergency Medicine rater

TXA is making important inroads for epistaxis. This is more confirmatory evidence for a safe and effective intervention. Not clear that atomizing offers benefits over TXA soaked gauze.

Emergency Medicine rater

Multiple studies have now evaluated the efficacy of TXA in epistaxis, but few standardize the ancillary care associated with ED management (external pressure, nasal packing, type of nasal packing, cautery). Different providers prefer different additional therapies, but previous studies have not reported these details. This study not only reports a protocol for external pressure + TXA, but also quantifies the added benefit of external pressure over Merocel packing, or external compression alone. This research provides guidance for future epistaxis management investigators to standardize and report efforts to improve hemostasis that are commonly additive to TXA.

Emergency Medicine rater

This article will be helpful to ED practitioners.
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