Methodology: 3/5
Usefulness: 3/5

Reuben A, et al. Ann Emerg Med. 2021 Feb 18:S0196-0644(20)31461-X.

Question and Methods: This was a double-blind, randomized controlled trial comparing topical tranexamic acid to placebo in patients presenting to the ED with epistaxis following failed vasoconstrictor treatment.
Findings: Topical administration of tranexamic did not reduce the need for anterior nasal packing compared with placebo (43.7% vs. 41.3, 95% CI -6.3% to 11.1)
Limitations: The study is limited by the absence of exclusion reasoning for a significant proportion of study participants raising the potential for selection bias.

Interpretation: This study casts doubt on the effectiveness of tranexamic acid for reducing the need for anterior nasal packing Рespecially in anticoagulated patients who accounted for 65% of the study’s participants.

By: Dr. David Kepecs


  • 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.