A meta-analysis on the efficacy of topical tranexamic acid for epistaxis: Does the method of administration affect the success rate?
Mansoureh Fatahi, Saba Aghajani, Yahya Samadi et al.
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In 30 seconds
This meta-analysis assessed topical tranexamic acid (TXA) for spontaneous anterior epistaxis in adults and whether administration method influenced outcomes. It included 18 studies (16 randomised trials and 2 prospective cohorts) involving 2760 patients, comparing TXA with standard care. TXA increased the odds of bleeding cessation within 10 min (OR 2.54; 95% CI 1.22; 5.29) and reduced early and late rebleeding. Results varied by delivery method: TXA-saturated gauze showed benefit, while atomized delivery had inconsistent results.
Key findings
- TXA increased the odds of bleeding cessation within 10 min (OR 2.54; 95% CI 1.22; 5.29).
- TXA reduced early rebleeding (OR 0.42; 95% CI 0.29; 0.59) and late rebleeding (OR 0.45; 95% CI 0.24; 0.87).
- TXA-saturated gauze showed a consistent benefit (OR 2.98), whereas atomized delivery yielded inconsistent results (OR 0.29).
- TXA shortened mean time to bleeding cessation (mean difference -4.68; 95% CI -7.02; -2.34).
Why it matters
The findings suggest that topical TXA may improve short-term bleeding control and reduce rebleeding in adult anterior epistaxis, outcomes relevant to emergency care. The variation by delivery method is clinically important: pooled efficacy may not apply equally across techniques, and the evidence points to more consistent results with TXA-saturated gauze than with atomized administration.
What to keep in mind
The evidence combines randomised trials and prospective cohorts, and the abstract notes that earlier syntheses were limited by small samples and high heterogeneity. Atomized-delivery results were inconsistent.