Potential interest of tranexamic acid for adult epistaxis control

SOURCE
Joseph J, Martinez-Devesa P, Bellorini J, Burton MJ (2018). Tranexamic acid for patients with nasal haemorrhage (epistaxis). Cochrane Database Syst Rev 12: CD004328.

CONTEXT
Epistaxis is a common presentation to emergency departments.  Prevalence is highest in children and in the elderly, especially in the context of taking treatments disrupting haemostasis. The use of tranexamic acid (TXA), the efficacy of which has already been demonstrated in some major bleeding disorders, is still uncertain in epistaxis.

CLINICAL QUESTION
Does TXA allow the control of epistaxis by stopping bleeding and/or preventing early recurrence? Is TXA well tolerated?

BOTTOM LINE
Previous studies have compared TXA (oral, intravenous or topical) with placebo in various dosing regimens. TXA promotes immediate control of epistaxis and reduces early recurrence risk at 10 days (moderate quality evidence). It does not influence blood transfusion rate in hospitalized patients and its impact on reducing the length of stay is equivocal (two conflicting studies). In subgroup analyses, only the repeated administrations of oral TXA over several days appears to be effective (moderate quality evidence). Topical TXA has an uncertain benefit (low quality evidence). The studies do not report any major side effects of TXA.
Recent studies on anterior epistaxis have focused on the use of TXA wicks or compresses compared to other local vasoconstrictor haemostatic treatments. TXA allows faster control (10 min) of epistaxis (moderate quality evidence), without higher rate of adverse events.

CAVEAT
This review analyzed only 6 studies with a small number of included subjects (all adults) and does not lead to a clear conclusion regarding the use of TXA in epistaxis.  Among included patients, subjects with hemostasis disruption were excluded. However, concomitant treatment with antiplatelet agents was not a systematic exclusion factor. Although outpatients were most represented, 2 studies involved only patients hospitalized for a few days in otolaryngology departments (oral TXA). Finally, there is no data on the need for additional procedures after TXA in case of persistent or recurrent epistaxis (surgery, embolization, etc.). Further studies are required to recommend TXA in the management of epistaxis.

AUTHORS INFORMATION

S. BEROUD
Service d’Accueil des urgences, Hospices civils de Lyon, CHU Lyon-Sud,
Lyon, France
sebastien.beroud@chu-lyon.fr

V.E. LVOVSCHI
Service d’Accueil des urgences, CHU Charles  civils de Lyon, CHU Lyon-Sud,
Rouen, France
sebastien.beroud@chu-lyon.fr

K. MAGEE
Dalhousie University – QEII Health Science Centre
Nova Scotia, Canada
kirk.magee@dal.ca