From the Guidelines
Topical tranexamic acid is a recommended treatment option for epistaxis, as it has been shown to provide higher rates of acute bleeding control and earlier discharge compared to anterior nasal packing. According to a study by Zahed et al 1, topical tranexamic acid was found to be effective in controlling acute nosebleeds, particularly in patients with anterior epistaxis. The study demonstrated that topical TXA resulted in higher rates of acute bleeding control and earlier discharge compared to anterior nasal packing.
When using topical tranexamic acid for epistaxis, it is essential to apply it directly to the bleeding site. This can be achieved by soaking cotton pledgets in tranexamic acid solution (500 mg/5 mL) and applying them to the bleeding site for 10-15 minutes while applying pressure to the nostrils. Alternatively, tranexamic acid can be administered as a nasal spray (100 mg/mL) with 1-2 sprays into each nostril up to 3-4 times daily during active bleeding.
The use of topical tranexamic acid is particularly beneficial for patients with coagulopathies or those on anticoagulant therapy, as it helps stabilize blood clots and promote hemostasis by inhibiting fibrinolysis 1. However, it is crucial to note that anticoagulation should not be discontinued solely for epistaxis management. Side effects of topical tranexamic acid are minimal, but patients should be monitored for rare allergic reactions. If bleeding persists despite tranexamic acid treatment, patients should seek medical attention for possible nasal packing or cauterization.
Key points to consider when using topical tranexamic acid for epistaxis include:
- Apply topical tranexamic acid directly to the bleeding site
- Use cotton pledgets soaked in tranexamic acid solution (500 mg/5 mL) or a nasal spray (100 mg/mL)
- Monitor patients for rare allergic reactions
- Do not discontinue anticoagulation solely for epistaxis management
- Seek medical attention if bleeding persists despite treatment, as noted in the study by Tunkel et al 1.
From the Research
Efficacy of Topical Tranexamic Acid in Epistaxis
- The use of topical tranexamic acid in the treatment of epistaxis has been investigated in several studies, with varying results 2, 3, 4, 5, 6.
- A study published in 2024 found that 1000 mg of topical tranexamic acid was more effective than 500 mg or saline in reducing bleeding frequency and rebleeding status in patients with anterior epistaxis 2.
- A systematic review and meta-analysis published in 2022 found that topical tranexamic acid was associated with better bleeding cessation rates after treatment compared to standard practices, with patients who received topical tranexamic acid being 3.5 times more likely to achieve bleeding cessation at the first assessment 4.
- However, a randomized controlled trial published in 2021 found that topical intranasal tranexamic acid did not reduce the need for anterior nasal packing in adult patients with persistent epistaxis, with no statistically significant differences between the tranexamic acid and placebo groups for any of the secondary outcome measures 5.
Safety and Side Effects
- The studies reviewed found that topical tranexamic acid was generally well-tolerated, with no significant differences in side effects or adverse events between the tranexamic acid and placebo groups 2, 3, 4, 5.
- One study reported a patient who developed a superficial thrombophlebitis of both legs following discharge, but it was not clear which group the patient was in 3.
Clinical Implications
- The current evidence suggests that topical tranexamic acid may be a useful adjunct in managing epistaxis, particularly in reducing bleeding frequency and rebleeding status 2, 4, 6.
- However, the results of the studies are not consistent, and further research is needed to fully understand the efficacy and safety of topical tranexamic acid in the treatment of epistaxis 3, 5.