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