title: Tranexamic acid in epistaxis: a systematic review.
abstract: BACKGROUND
  The role of tranexamic acid in the management of epistaxis remains unclear. There is uncertainty about its safety and about the contraindications for its use. We performed a systematic review of the use of systemic and topical tranexamic acid in epistaxis and a comparative review of its use in other specialties.
  
  
  OBJECTIVE
  This review assesses and summarises the existing evidence for the efficacy and safety of tranexamic acid in the management of epistaxis.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  MEDLINE and EMBASE were searched for 'epistaxis' and equivalent MESH terms, combined with the Boolean operator 'OR' and 'tranexamic acid'. The Cochrane library and society guidelines were reviewed for evidence regarding the use of tranexamic acid in other specialties.
  
  
  METHODS
  All five relevant RCTs were included in the review and were evaluated according to the recommendations of the Cochrane Handbook for Systematic Reviews.
  
  
  RESULTS
  Three RCTS pertained to spontaneous epistaxis; of these, one trial found no benefit of oral tranexamic acid in acute epistaxis, one trial found no significant benefit of topical tranexamic acid, but the largest of the trials showed significant benefit of topical tranexamic acid in acute epistaxis management. Two RCTs examined oral tranexamic acid for prophylaxis of recurrent epistaxes in patients with hereditary haemorrhagic telangiectasia; both showed significant reduction in severity and frequency.
  
  
  CONCLUSIONS
  Tranexamic acid, as a WHO 'essential medicine', is a powerful, readily available tool, the use of which in epistaxis has been limited by uncertainty over its efficacy and its safety profile. This systematic review summarises the existing evidence and extrapolates from the wealth of data for other specialties to address the clinical question - does TXA have a role in epistaxis management?
authors.affiliation: ENT Department, Royal Glamorgan Hospital, Llantrisant, Wales, UK.
authors.forename: Y
authors.initials: Y
authors.lastname: Kamhieh
authors.affiliation: ENT Department, Royal Glamorgan Hospital, Llantrisant, Wales, UK.
authors.forename: H
authors.initials: H
authors.lastname: Fox
mesh_terms: D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D004844:Epistaxis / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D014148:Tranexamic Acid / Q000627:therapeutic use*
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid