Topical Tranexamic Acid versus Phenylephrine-lidocainefor the Treatment of Anterior Epistaxis in Patients TakingAspirin or Clopidogrel; a Randomized Clinical Trial

Epistaxis is one of the most prevalent complaints in the emergency department (ED), especiallyin patients who take antiplatelet agents. This study aimed to compare the effect of topical use of tranexamicacid (TXA) with phenylephrine-lidocaine anterior nasal packing (PANP) in controlling epistaxis of patients whotake aspirin or clopidogrel.

This prospective, double-blind, parallel-group, randomized clinical trialwas conducted to compare the effect of topical use of intravenous (IV ) TXA compared with PANP on controllinganterior epistaxis in patients who take aspirin or clopidogrel.

One hundred patients with the mean ageof 59.24±7.75 (45 – 75) years were studied (52% male). Two groups were similar in terms of age (p=0.81) and sex(p=0.23) distribution, diabetes mellitus (p=0.54), and hypertension (p = 0.037). The mean time to stop bleed-ing was 6.70±2.35 minutes in the TXA group and 11.50±3.64 minutes in the PANP group (p=0.002). Bleedingrecurrence occurred in 3 (6%) cases of the TXA group and 10 (20%) cases of the PANP group (p =0.03). Timeto discharge from ED in the TXA group was significantly lower than the PANP group (p<0.001). The absoluterisk reduction (ARR), relative risk reduction, and number needed to harm of treatment with TXA for anteriornasal bleeding were 14.00% (95%CI: 1.11 – 26.89), 17.50% (95%CI: 0.60 - 37.27), and 7.14 (95%CI: 3.71 -90.43),respectively.

Topical TXA is an appropriate treatment option in bleeding cessation, and reducingre-bleeding and duration of hospital stay in patients with epistaxis who take antiplatelet agents.