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.