- Temple EM
Nasal Packing vs TXA for Anterior Nose Bleeds
The Article: A new and rapid method for epistaxis treatment using injectable form of tranexamic acid topically: a randomized controlled trial
American Journal of Emergency Medicine 31 (2013) 1389-1392
The Idea: To determine if using a topical form of TXA is more efficacious than nasal packing in stopping anterior epistaxis
The Study:
Single center, randomized control trial of 216 patients
Inclusion criteria: idiopathic anterior epistaxis
Exclusion criteria: trauma, posterior epistaxis, known bleeding disorder, INR > 1.5, shock, visible bleeding vessel
PGY3 residents received 2-hr workshop in order to standardize nasal packing method
TXA group: cotton pledget soaked in injectable form of TXA (5ml of 100mg/ml) for 10min and placed in nasal cavity; bleeding was assessed q5min
Nasal packing group: cotton pledget soaked in lidocaine and epinephrine and placed in nasal cavity for 10min to shrink nasal mucosa; then cotton pledgets coated in tetracycline were packed; packing was removed in 3 days
Outcomes:
Bleeding stop time
Discharge from ED time
Re-bleeding in the first 24h and in 1wk
Patient satisfaction score on scale of 0 to 10
Complications in the ED
The Findings:
Decreased bleeding time in TXA group: 71% of TXA patents vs 31.2% of nasal packing patients had bleeding stop time of < 10 min
Decreased time to discharge in TXA group: 95.3% of TXA patients vs 6.4% of nasal packing patients were discharged from the ED in < 2 hrs
Decreased rate of re-bleeding in TXA group at 24h and 1wk: 4.7% vs 12.8%, and 2.8% vs 11%
Patient satisfaction score was greater in the TXA group: 8.5 vs 4.4
No difference in complication rate (i.e. nausea/vomiting)
Limitations:
Residents and patients not blinded
Nasal packing method not disclosed, and is not standardized across other hospitals
No information on severity of bleeding
TXA not readily available everywhere
Small study – 216 patients
No cost analysis
The Takeaway:
TXA is more efficacious and convenient than nasal packing in treating idiopathic anterior epistaxis. Treatment with TXA liberates patients from being discharged with uncomfortable nasal packing, taking antibiotics, and a return trip to have the packing removed. Patients are more satisfied with shorter ER visits, as are physicians with increased throughput, without an increased risk in re-bleeding or complications.