Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Nov 19;9(1):e6.
doi: 10.22037/aaem.v9i1.875. eCollection 2021.

Topical Tranexamic Acid versus Phenylephrine-lidocaine for the Treatment of Anterior Epistaxis in Patients Taking Aspirin or Clopidogrel; a Randomized Clinical Trial

Keyvan Amini  1 , AmirAhmad Arabzadeh  2 , Sevda Jahed  3 , Payman Amini  3
Affiliations

Topical Tranexamic Acid versus Phenylephrine-lidocaine for the Treatment of Anterior Epistaxis in Patients Taking Aspirin or Clopidogrel; a Randomized Clinical Trial

Keyvan Amini et al. Arch Acad Emerg Med. .

Abstract

Introduction: Epistaxis is one of the most prevalent complaints in the emergency department (ED), especially in patients who take antiplatelet agents. This study aimed to compare the effect of topical use of tranexamic acid (TXA) with phenylephrine-lidocaine anterior nasal packing (PANP) in controlling epistaxis of patients who take aspirin or clopidogrel.

Methods: This prospective, double-blind, parallel-group, randomized clinical trial was conducted to compare the effect of topical use of intravenous (IV) TXA compared with PANP on controlling anterior epistaxis in patients who take aspirin or clopidogrel.

Results: One hundred patients with the mean age of 59.24 ± 7.75 (45 - 75) years were studied (52% male). Two groups were similar in terms of age (p=0.81) and sex (p=0.23) distribution, diabetes mellitus (p=0.54), and hypertension (p = 0.037). The mean time to stop bleeding was 6.70 ± 2.35 minutes in the TXA group and 11.50±3.64 minutes in the PANP group (p=0.002). Bleeding recurrence occurred in 3 (6%) cases of the TXA group and 10 (20%) cases of the PANP group (p =0.03). Time to discharge from ED in the TXA group was significantly lower than the PANP group (p<0.001). The absolute risk reduction (ARR), relative risk reduction, and number needed to harm of treatment with TXA for anterior nasal bleeding were 14.00% (95%CI: 1.11 - 26.89), 17.50% (95%CI: 0.60 - 37.27), and 7.14 (95%CI: 3.71 -90.43), respectively.

Conclusion: Topical TXA is an appropriate treatment option in bleeding cessation, and reducing re-bleeding and duration of hospital stay in patients with epistaxis who take antiplatelet agents.

Keywords: Aspirin; Clopidogrel; Emergency Medical Services; Epistaxis; Tranexamic Acid; lidocaine drug combination; phenylephrine.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Patient allocation flowchart. PANP: phenylephrine/lidocaine soaked anterior nasal packing; TXA: tranexamic acid
See this image and copyright information in PMC

References

    1. Viehweg TL, Roberson JB, Hudson J. Epistaxis: diagnosis and treatment. Journal of oral and maxillofacial surgery. 2006;64(3):511–8. - PubMed
    1. Chaaban MR, Zhang D, Resto V, Goodwin JS. Demographic, seasonal, and geographic differences in emergency department visits for epistaxis. Otolaryngology–Head and Neck Surgery. 2017;156(1):81–6. - PubMed
    1. Bell MD G. Management of Epistaxis. 2016.
    1. Tabassom A, Cho JJ. Epistaxis. Epistaxis (nose bleed). StatPearls [Internet] 2020.
    1. Svider P, Arianpour K, Mutchnick S. Management of epistaxis in children and adolescents: avoiding a chaotic approach. Pediatric Clinics. 2018;65(3):607–21. - PubMed

LinkOut - more resources