Topical tranexamic acid for the treatment of acute epistaxis in the emergency department

Asha R. Birmingham, Nathan D. Mah, Ran Ran, Matthew Hansen

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective: To evaluate the effectiveness and potential benefits of topical tranexamic acid (TXA) in the management of acute epistaxis. Methods: Retrospective review was performed among all patients presenting to the institution's emergency department (ED) with epistaxis between September 2014 and August 2016. Patients achieving hemostasis with standard of care agents, such as oxymetazoline, lidocaine, or epinephrine were excluded. The primary outcome was the ED length of stay (LOS). Secondary outcomes included the incidence of hospital admission, otolaryngologist consultation, nasal packing, prophylactic antibiotic use, and ED visit for rebleeding within seven days of treatment. Results: Among 122 patients, 30 received topical TXA (500 mg injectable solution soaked onto packing material and applied to the affected nostril) and 92 were managed with standard care. Nearly half (46.7%) of TXA-treated subjects received TXA either alone or in combination with standard of care agents as their initial treatment strategy. No significant difference was observed in the ED LOS (272 vs 232 min in TXA and standard care arms, respectively, p = 0.26). However, TXA was associated with a significant reduction in otolaryngologist consults (30.0% vs 65.2%, p = 0.002) and nasal packing (16.7% vs 23.9%, p = 0.003). Conclusions: This investigation did not demonstrate a significant difference in ED LOS among patients with acute epistaxis treated with topical TXA or standard care. However, this data does add to existing evidence that TXA may be associated with a reduction in resource utilization, suggesting it may provide more effective bleeding control. Overall, more data is needed to confirm the potential benefits of this practice.

Original languageEnglish (US)
Pages (from-to)1242-1245
Number of pages4
JournalAmerican Journal of Emergency Medicine
Volume36
Issue number7
DOIs
StatePublished - Jul 1 2018

Fingerprint

Tranexamic Acid
Epistaxis
Hospital Emergency Service
Length of Stay
Therapeutics
Standard of Care
Nose
Oxymetazoline
Lidocaine
Hemostasis
Epinephrine
Referral and Consultation
Hemorrhage
Anti-Bacterial Agents
Injections
Incidence

Keywords

  • Acute epistaxis
  • Emergency medicine
  • Intranasal
  • Nosebleed
  • Otolaryngology
  • Pharmacy
  • Topical
  • Tranexamic acid

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Topical tranexamic acid for the treatment of acute epistaxis in the emergency department. / Birmingham, Asha R.; Mah, Nathan D.; Ran, Ran; Hansen, Matthew.

In: American Journal of Emergency Medicine, Vol. 36, No. 7, 01.07.2018, p. 1242-1245.

Research output: Contribution to journalArticle

Birmingham, Asha R. ; Mah, Nathan D. ; Ran, Ran ; Hansen, Matthew. / Topical tranexamic acid for the treatment of acute epistaxis in the emergency department. In: American Journal of Emergency Medicine. 2018 ; Vol. 36, No. 7. pp. 1242-1245.
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abstract = "Objective: To evaluate the effectiveness and potential benefits of topical tranexamic acid (TXA) in the management of acute epistaxis. Methods: Retrospective review was performed among all patients presenting to the institution's emergency department (ED) with epistaxis between September 2014 and August 2016. Patients achieving hemostasis with standard of care agents, such as oxymetazoline, lidocaine, or epinephrine were excluded. The primary outcome was the ED length of stay (LOS). Secondary outcomes included the incidence of hospital admission, otolaryngologist consultation, nasal packing, prophylactic antibiotic use, and ED visit for rebleeding within seven days of treatment. Results: Among 122 patients, 30 received topical TXA (500 mg injectable solution soaked onto packing material and applied to the affected nostril) and 92 were managed with standard care. Nearly half (46.7{\%}) of TXA-treated subjects received TXA either alone or in combination with standard of care agents as their initial treatment strategy. No significant difference was observed in the ED LOS (272 vs 232 min in TXA and standard care arms, respectively, p = 0.26). However, TXA was associated with a significant reduction in otolaryngologist consults (30.0{\%} vs 65.2{\%}, p = 0.002) and nasal packing (16.7{\%} vs 23.9{\%}, p = 0.003). Conclusions: This investigation did not demonstrate a significant difference in ED LOS among patients with acute epistaxis treated with topical TXA or standard care. However, this data does add to existing evidence that TXA may be associated with a reduction in resource utilization, suggesting it may provide more effective bleeding control. Overall, more data is needed to confirm the potential benefits of this practice.",
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