title: A new and rapid method for epistaxis treatment using injectable form of tranexamic acid topically: a randomized controlled trial.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  Topical application of injectable form of tranexamic acid was better than anterior nasal packing in the initial treatment of idiopathic anterior epistaxis.
authors.affiliation: Department of Emergency Medicine, Imam Khomeini Hospital Complex, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Zahed
authors.forename: Payman
authors.initials: P
authors.lastname: Moharamzadeh
authors.forename: Saeid
authors.initials: S
authors.lastname: Alizadeharasi
authors.forename: Asghar
authors.initials: A
authors.lastname: Ghasemi
authors.forename: Morteza
authors.initials: M
authors.lastname: Saeedi
mesh_terms: D000281:Administration, Intranasal; D000933:Antifibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004636:Emergency Service, Hospital; D004844:Epistaxis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013997:Time Factors; D014148:Tranexamic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid