Methodology Score: 2.5/5
Usefulness Score: 2.5/5

Akkan S, et al. Ann Emerg Med. 2019 Jul;74(1):72-78

Question and Methods: Prospective RCT comparing compression with saline, compression with tranexamic acid, and nasal packing with merocel for anterior epistaxis.

Findings: No difference in 15-minute bleeding cessation for TXA (91.1%) or packing (93.3%), v/s saline (71.1%).  Lower 24h rebleeding for TXA (86.7%) compared to packing (74%).

Limitations: Blinding not possible for packing and outcomes are subjective leading to potentially significant performance bias.

Interpretation: For anterior epistaxis, compression with TXA and nasal packing are feasible.  More studies are needed to prove clinically significant differences in outcomes.

By: Dr. Jessica McCallum


  • Hans Rosenberg

    Dr. Rosenberg is an emergency physician at the Ottawa Hospital, assistant professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.