HWN Suggests

NoPAC: No benefit from TXA in epistaxis

For the last two decades, TXA has been put on a pedestal in emergency medicine. It has been sold as the perfect drug: life saving with absolutely no side effects. The silver bullet. Unfortunately, the evidence for this ‘wonder drug’ has never been that great.

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 Epistaxis TXA Pack

Jess Mason reviews how to use tranexamic acid (TXA) in an anterior nasal pack for epistaxis that is not resolving wtih compression and vasoconstrictors. We use 1,000 mg of TXA (10 ml), soak gauze, and insert it into the nasal cavity. After 20 minutes the epistaxis has resolved and the packing is removed.

 Meta-Analysis on Topical TXA for Epistaxis

Maybe a better strategy would be direct pressure PLUS TXA as a 1st line approach to epistaxis as it appears from this study that it does a better job in bleeding cessation when compared to other vasoconstrictors.

 The Times they are a Changin' for TXA in Epistaxis?

We would have tweaked their conclusions to say “In select patients (majority taking anticoagulant medication) presenting to an ED with atraumatic epistaxis that is uncontrolled with simple first aid measures and the application of a topical vasoconstrictor, 200mg-400mg of TXA applied in the bleeding nostril on a cotton wool dental roll is no more effective than placebo at controlling bleeding and reducing the need for anterior nasal packing”.

 TXA: Still a Gold Medal for Stopping the Bleed?

Although the largest trial demonstrates similar results versus placebo, TXA may still be considered as it is a low cost, noninvasive, nonpainful treatment option with a low adverse event rate.

Articles of Interest

(Don't) Let it Bleed – TXA for Epistaxis in Patients on Anti-Platelet Drugs

Using topical tranexamic acid for epistaxis in the context of antiplatelet drug use seems to result in faster bleeding cessation, less re-bleeding at one week, and higher patient satisfaction.

Topical TXA in Epistaxis

Tranexamic acid (TXA) soaked cotton pledget (500 mg TXA in 5 ml). The use of topical TXA is painless, non-invasive and relatively inexpensive. Providers should consider the use of this approach in patients with anterior epistaxis who fail direct pressure prior to placement of an anterior pack.

Tranexamic acid in epistaxis

In this episode we cover the literature on tranexamic acid (TXA) in epistaxis, including a new trial in Annals of Emergency Medicine by Reuben et al, the NoPac trial.

TXA In Epistaxis

We have come a long way from the old days of petroleum jelly ribbon packing which was uncomfortable, time consuming and often less effective. Rapid Rhino, Merocel and similar products have really simplified nosebleed management but they are still uncomfortable, require oral antibiotics, and mandate close follow up for removal. In addition, they are associated with a risk of infection and even hypoxia in predisposed patients.

TXA Superior to Packing for Epistaxis, and Patients Like It Better

15-cm cotton pledget soaked in the injectable form of TXA (500 mg in 5 mL). The most difficult aspect of the approach (at least in our EDs) is coordinating with the pharmacy to attain the injectable TXA, but otherwise there is little downside to adding TXA to your nosebleed armamentarium. If I ever get cracked in the honker again and need epistaxis care, I'll be asking for TXA.