Topical Intranasal Tranexamic Acid for Epistaxis in the Emergency Department

This is a prospective, randomized, single-center, double-blinded, placebo controlled study
comparing efficacy and safety of topical intranasal tranexamic acid for epistaxis. The
primary outcome was time to control of bleeding and secondary outcomes were length of stay in
the emergency department, re-bleeding within the first 24 hours, and re-bleeding at one week.
Safety outcomes were the incidence of thromboembolic events and other drug-related adverse
events.

Patients aged 18 years of age or older and diagnosed with anterior epistaxis were included.
Patients were excluded if they were unable to consent, do not have a valid telephone number,
pregnant women, prisoners, cognitively impaired individuals, diagnosis of posterior
epistaxis, major trauma, bleeding disorder (such as thrombocytopenia or hemophilia),
hemodynamically unstable, or had a known hypersensitivity to study medication.

Patients were randomly assigned to tranexamic acid treatment group or placebo group. After
consenting, patients received TXA (100 mg/1mL) or 0.9% sodium chloride (1 mL) in to the
affected nostril(s) via intranasal atomization device. If bleeding did not cease, two repeat
doses were allowed and after twenty minutes of continued bleeding the study physician could
treat with any additional treatment options. Patients were contacted via telephone within one
week to inquire about incidences of re-bleeding or any complications.

Inclusion Criteria:

- Diagnosed with anterior epistaxis

Exclusion Criteria:

- Unable to consent, do not have a valid telephone number, pregnant women, prisoners,
cognitively impaired individuals, diagnosis of posterior epistaxis, major trauma,
bleeding disorder (such as thrombocytopenia or hemophilia), hemodynamically unstable,
or had a known hypersensitivity to study medication