transexamic acid for epistaxis?

29 Aug

recent article on use of transexamic acid (which binds plasminogen and prevents it turning into plasmin):


Randomized trial for anterior bleeding:

using soaked cotton pledgets with TXA in one group vs. cotton pledget with epinephrine + lidocaine for ten minutes and packing with several cotton pledgets covered with tetracycline.  Nasal packing was removed after 3 days.


  • significantly higher rate of bleeding arrest in TXA group (71% to 31%)
  • significantly higher discharge with TXA at 2 hours or less (95% vs 6.4%),
  • non-significant rates of rebleeding at 24 hours (4.7% TXA vs 11% ANP).
  • higher patient satisfaction in the TXA group. 


However, it should be noted that this is not compared to rapid rhino or other commercially available products, simply to anterior nasal packing with cotton pledgets in place for ten minutes. No mention of holding pressure was noted.



Submitted by J. Stone. 


References: Zahed R et al. A new and rapid method for epistaxis treatment using injectable form of tranexamic acid topically: a randomized controlled trial. Am J Emerg Med. 2013 Sep;31(9):1389-92. PMID: 23911102.; picture


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