A meta-analysis on the efficacy of topical tranexamic acid for epistaxis: Does the method of administration affect...

Topical Tranexamic Acid is increasingly used for epistaxis, but previous evidence syntheses have reported low certainty due to small sample sizes and high heterogeneity. We aimed to evaluate the efficacy of topical tranexamic acid in adult anterior epistaxis and identify clinical factors, specifically the method of administration, that influence treatment success.

We systematically searched PubMed, Embase, SCOPUS, and Web of Science for studies comparing topical tranexamic acid to standard care (nasal packing, vasoconstrictors, or placebo) for spontaneous anterior epistaxis. The primary outcome was bleeding cessation within 10 min. Secondary outcomes included emergency department length of stay and rebleeding rates (early and late). A subgroup analysis was conducted to compare the effects of different delivery methods on the success rate.

Eighteen studies (16 RCTs, 2 prospective cohorts) involving 2760 patients were included. Topical tranexamic acid significantly reduced the mean time required to bleeding cessation, with a mean difference of -4.68 (95% CI -7.02; -2.34). Furthermore, it enhanced the probability of achieving bleeding cessation within 10 min (OR 2.54; 95% CI 1.22; 5.29) and reduced the risk of both early rebleeding (OR 0.42; 95% CI 0.29; 0.59) and late rebleeding (OR 0.45; 95% CI 0.24; 0.87). Patients treated with tranexamic acid were five times more likely to be discharged from the ED within two hours (OR 5.53). Subgroup analysis revealed that the method of administration was a critical moderator: tranexamic acid-saturated gauze provided a robust, consistent benefit (OR 2.98), whereas atomized delivery yielded inconsistent results (OR 0.29). Sensitivity analysis restricted to RCTs confirmed the stability of the primary effect (OR 2.50).

Topical TXA could be superior to traditional management strategies for adult anterior epistaxis, offering faster hemostasis, reduced rebleeding, and shorter emergency department stays. However, efficacy is technique-dependent; saturated gauze/pledgets should be preferred over atomized delivery to ensure optimal and consistent treatment effect.