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
Dr. Rosenberg is an emergency physician at the Ottawa Hospital, associate professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.
Dr. Debra Eagles obtained her degree and residency training in Emergency Medicine from the University of Ottawa. She has a special interest in altered mental status, both dementia and delirium, frailty, and geriatric trauma.