Methodology: 4/5
Usefulness: 4/5

Hosseinialhashemi M, et al. Ann Emerg Med. 2022 Sep;80(3):182-188. doi: 10.1016/j.annemergmed.2022.04.010.

Question and methods: This was a double blinded RCT single center in a specialized ENT ED in Iran, comparing topical intranasal TXA in anterior epistaxis vs. standard care which included cotton soaked pledgets with phenylephrine and lidocaine.
Findings: TXA associated with lower need for anterior nasal packing with an ARR 14% and NNT 7.14
Limitations:  Limitations include specialist assessments and treatments. Does not fit with our patient population that have refractory anterior epistaxis as they are anti-coagulated. High numbers of patients in this study still required electrocautery which is not available to us in urgent care in EDs across Canada.  

Interpretation: Clinicians should consider the use of intranasal tranexamic acid in patients with atraumatic anterior epistaxis and have a low risk of severe bleed.  

By: Dr. Dominique Trudel

JC Supervisor: Dr. Debra Eagles