Monday, February 22, 2021

TXA in epistaxis

First10EM - February 22, 2021 - By Justin Morgenstern
... “The NoPAC trial is the highest quality trial to date looking at TXA for epistaxis, but before diving into that trial, I thought I would share what I had previously written about this literature. My bottom line for the Journal Jam Episode was: The level of evidence is weak, and so I wouldn’t be surprised if it was overturned in the future, but the current evidence does support the use of TXA (either topical or oral) to reduce the risk of rebleeding. There is no evidence that it reduces more important outcomes like transfusions, need for interventions, or surgery...
The paper
Reuben A, Appelboam A, et al. The use of tranexamic acid to reduce the need for Nasal Packing in Epistaxis (NoPac): randomised controlled trial. Annals of Emergency Medicine. 2021. 10.1016/j.annemergmed.2020.12.013
Bottom line
In the highest quality trial to date, there was absolutely no value in using topical TXA in the management of epistaxis.”