From the Guidelines
Tranexamic acid (TXA) should be left in the nose for 3-7 days, with 1-2 sprays in each nostril 2-3 times per day, as this duration allows enough time for the nasal tissue to heal while preventing recurrent bleeding, as supported by the most recent and highest quality study 1. To use:
- Gently blow your nose before application
- Tilt your head slightly forward
- Insert the nozzle into one nostril and spray while inhaling gently
- Repeat for the other nostril
- Avoid blowing your nose for at least 15 minutes after application TXA works by promoting blood clotting locally, which helps stop nosebleeds. The 3-7 day duration is based on the clinical practice guideline for nosebleed (epistaxis) 1, which suggests that the duration of placement of non-resorbable anterior nasal packing varies per severity and location of bleeding and medical comorbidities, but typically ranges from 48 hours to 72 hours or even longer. However, if bleeding persists or worsens, seek medical attention promptly. Some studies suggest that TXA can be effective in controlling acute nosebleeds, with higher rates of acute bleeding control and earlier discharge compared to anterior nasal packing 1. Additionally, TXA has been shown to be effective in patients taking antiplatelet drugs, such as aspirin and/or clopidogrel 1. However, the most recent and highest quality study 1 provides the best evidence for the duration of TXA use in the nose.
From the Research
Duration of Tranexamic Acid (TXA) Application
- The optimal duration for leaving tranexamic acid (TXA) in the nose is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, one study compared the efficacy of topical TXA with anterior nasal packing for the treatment of epistaxis in patients taking antiplatelet drugs, and found that bleeding was stopped in 73% of patients in the TXA group within 10 minutes of treatment 3.
- Another study found that topical TXA reduced the risk of re-bleeding from 66% to 43% after a single application, but the quality of evidence for this outcome was rated as low 2.
- There is no clear guidance on the duration of TXA application, but it appears that a single application may be sufficient to control bleeding in some cases.
Factors Influencing TXA Application Duration
- The effectiveness of TXA in controlling epistaxis may depend on various factors, including the severity of the bleeding, the presence of underlying medical conditions, and the use of antiplatelet or anticoagulant medications 3, 4, 5, 6.
- Further research is needed to determine the optimal duration of TXA application and to establish clear guidelines for its use in the management of epistaxis.