From the Guidelines
Topical tranexamic acid is a recommended treatment for epistaxis due to its effectiveness in controlling acute bleeding and preventing recurrent episodes, as evidenced by studies such as Zahed et al 1. For acute nosebleeds, applying cotton pledgets soaked in tranexamic acid solution (500 mg/5 mL) directly into the bleeding nostril for 10-15 minutes is a suggested approach. Alternatively, tranexamic acid can be administered as a nasal spray (100 mg/mL) with 1-2 sprays into the affected nostril, repeated if needed after 10 minutes. The use of topical tranexamic acid has been shown to be beneficial in patients taking antiplatelet drugs, such as aspirin and/or clopidogrel, as it provides more effective acute control of anterior nosebleeds compared to standard anterior nasal packing 1. Key benefits of topical tranexamic acid include its ability to inhibit fibrinolysis, which stabilizes blood clots and promotes hemostasis, making it particularly useful for controlling mucosal bleeding like epistaxis. The topical application minimizes systemic absorption and associated side effects while providing direct hemostatic action at the bleeding site. Patients should be instructed to apply gentle pressure to the soft part of the nose for 10-15 minutes after application and to avoid nasal picking or trauma. If bleeding persists despite treatment, medical attention should be sought as nasal packing or cauterization may be necessary, as outlined in clinical practice guidelines 1. It is essential to consider the patient's quality of life and the potential complications of treatment modalities when managing epistaxis, and topical tranexamic acid has been found to be a safe and effective option in various studies, including those published in reputable journals such as Otolaryngology--head and neck surgery 1.
From the Research
Topical Tranexamic Acid for Epistaxis
- The use of topical tranexamic acid for epistaxis has been studied in several clinical trials 2, 3, 4, 5.
- A randomized controlled trial published in 2019 proposed to investigate the effectiveness of topical intranasal tranexamic acid in reducing the need for anterior nasal packing in patients with persistent epistaxis 2.
- Another study published in 2024 compared the therapeutic superiority of saline to that of 500 and 1000 mg doses of topical tranexamic acid for the treatment of anterior epistaxis, and found that 1000 mg of tranexamic acid was recommended due to its decreased rate of recurrent bleeding and low incidence of side effects 3.
- A review of the evidence for the use of topical tranexamic acid in treating epistaxis found that it may be a useful adjunct in managing epistaxis 4.
- However, a randomized controlled trial published in 2021 found that topical tranexamic acid was no more effective than placebo at controlling bleeding and reducing the need for anterior nasal packing in patients with atraumatic epistaxis 5.
Dosage and Efficacy
- The optimal dose of topical tranexamic acid for epistaxis is not well established, but a study suggested that 1000 mg may be more effective than 500 mg 3.
- The efficacy of topical tranexamic acid in reducing the need for anterior nasal packing and controlling bleeding in patients with epistaxis is still a topic of debate, with some studies showing promising results 2, 3, 4 and others finding no significant difference compared to placebo 5.