A new and rapid method for epistaxis treatment using injectable form of tranexamic acid topically: a randomized controlled trial

Published:August 01, 2013DOI:



      Epistaxis is a common problem in the emergency department (ED). Sixty percent of people experience it at least once in their life. There are different kinds of treatment for epistaxis. This study intended to evaluate the topical use of injectable form of tranexamic acid vs anterior nasal packing with pledgets coated with tetracycline ointment.


      Topical application of injectable form of tranexamic acid (500 mg in 5 mL) was compared with anterior nasal packing in 216 patients with anterior epistaxis presented to an ED in a randomized clinical trial. The time needed to arrest initial bleeding, hours needed to stay in hospital, and any rebleeding during 24 hours and 1 week later were recorded, and finally, the patient satisfaction was rated by a 0-10 scale.


      Within 10 minutes of treatment, bleedings were arrested in 71% of the patients in the tranexamic acid group, compared with 31.2% in the anterior nasal packing group (odds ratio, 2.28; 95% confidence interval, 1.68-3.09; P < .001). In addition, 95.3% in the tranexamic acid group were discharged in 2 hours or less vs 6.4% in the anterior nasal packing group (P < .001). Rebleeding was reported in 4.7% and 11% of patients during first 24 hours in the tranexamic acid and the anterior nasal packing groups, respectively (P = .128). Satisfaction rate was higher in the tranexamic acid compared with the anterior nasal packing group (8.5 ± 1.7 vs 4.4 ± 1.8, P < .001).


      Topical application of injectable form of tranexamic acid was better than anterior nasal packing in the initial treatment of idiopathic anterior epistaxis.
      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Viehweg T.L.
        • Roberson J.B.
        • Hudson J.W.
        Epistaxis: diagnosis and treatment.
        J Oral Maxillofac Surg. 2006; 64: 511-518
        • Doyle D.E.
        Anterior epistaxis: a new nasal tampon for fast, effective control.
        Laryngoscope. 1986; 96: 279-281
        • Stell P.M.
        Clin Otolaryngol Allied Sci. 1977; 2: 263-273
        • Bertrand B.
        • Eloy P.
        • Rombaux P.
        • et al.
        Guidelines to the management of epistaxis.
        B-ent. 2005; 1: 27-43
        • Aeumjaturapat S.
        • Supanakorn S.
        • Cutchavaree A.
        Toxic shock syndrome after anterior-posterior nasal packing.
        J Med Assoc Thai. 2001; 84: 453-458
        • Burton M.J.
        • Doree C.J.
        Interventions for recurrent idiopathic epistaxis (nosebleeds) in children.
        Cochrane Database Syst Rev. 2004; 1: CD004461
        • Sabbà C.
        • Gallitelli M.
        • Palasciano G.
        Efficacy of unusually high doses of tranexamic acid for the treatment of epistaxis in hereditary hemorrhagic telangiectasia.
        N Engl J Med. 2001; 345: 926
        • Jash D.
        Epistaxis—topical use of epsilonaminocaproic acid in its management.
        J Laryngol Otol. 1973; 87: 895-898
        • White A.
        • O'reilly B.
        Oral tranexamic acid in the management of epistaxis.
        Clin Otolaryngol Allied Sci. 2007; 13: 11-16
        • Tibbelin A.
        • Aust R.
        • Bende M.
        • et al.
        Effect of local tranexamic acid gel in the treatment of epistaxis.
        ORL J Otorhinolaryngol Relat Spec. 1995; 57: 207-209
        • Daly L.E.
        • Bourke G.J.
        Interpretation and uses of medical statistics. 5th ed. Blackwell Science Ltd, Oxford2000
        • Petruson B.
        Epistaxis. A clinical study with special reference to fibrinolysis.
        Acta Otolaryngol Suppl. 1974; 317: 1-73
        • Klepfish A.
        • Berrebi A.
        • Schattner A.
        Intranasal tranexamic acid treatment for severe epistaxis in hereditary hemorrhagic telangiectasia.
        Arch Intern Med. 2001; 161: 767
        • Thorsen S.
        Differences in the binding to fibrin of native plasminogen and plasminogen modified by proteolytic degradation. Influence of omega-aminocarboxylic acids.
        Biochim Biophys Acta. 1975; 393: 55-65
        • Hoylaerts M.
        • Lijnen H.R.
        • Collen D.S.
        Studies on the mechanism of the antifibrinolytic action of tranexamic acid.
        Biochimica et Biophysica Acta. 1981; 673: 75-85