Introduction: Epistaxis is a common condition witnessed in the Emergency department. Due to the discomfort patients experience, the likelihood of complications, and the necessity of following up with their treating physician to remove the nasal packing, it may be reasonable to utilize other drugs to treat epistaxis before nasal packing. It is well-recognized that the antifibrinolytic drug tranexamic acid (TXA) is helpful in various therapeutic contexts where uncontrolled bleeding may be an issue. There is anecdotal data that suggests topical TXA may be helpful for acute epistaxis, but more research is needed.
Material and Method: The Patients were divided into two groups- Group T- A cotton pledget soaked in 5ml of Tranexamic acid (prefilled syringe) and 10 ml of Phenylephrine with 5ml of 2% Lignocaine with 1:1000 adrenaline and Group C- A cotton pledget soaked in 10ml of Phenylephrine with 5ml of 2% Lignocaine with 1:1000 adrenaline with 5ml Normal saline (prefilled syringe). Outcomes recorded were the proportion of patients in both groups who needed anterior nasal packing after 20 minutes of pack removal, the number of patients whose bleeding stopped within ten minutes, the length of stay in the ED, the necessity of cauterization, and a telephonic follow-up conducted by an independent ENT resident using a structured questionnaire to record any episode of rebleeding within 24 hours to five days. Any drug-related side effects were recorded, such as thrombosis, nausea, and hypersensitivity.
Result: Patients requiring anterior nasal packs were less in the Tranexamic acid group (P<0.038). The length of hospital stay was decreased in Group T (P <0.045), and the proportion of patients whose bleeding was stopped within 10 mins was more in Group T (P< 0.04). The incidence of rebleeding within 24 hours decreased in Group T (P< 0.038), but no significant difference was found in rebleeding number within 1- 5 days. No minor/major complications to the drug were noted in Group T.
Conclusion: Topical TXA is safe and effective for the cessation of anterior nasal bleeding, thus preventing the use of anterior nasal packing, which is tedious for the patient and medical staff. TXA has been shown to decrease the rate of packing significantly.
