Effect of Topical Tranexamic Acid in Acute Spontaneous Epistaxis: A Randomized Controlled Trial

Persistent epistaxis and early rebleeding remain clinical challenges despite the self-limiting nature of many cases. Identification of a simple, noninvasive strategy for hemostasis and recurrence prevention remains a clinical priority. Topical tranexamic acid (TXA) is a potential hemostatic agent, but evidence regarding its effectiveness, particularly for rebleeding, is limited and inconsistent. This study evaluated the role of topical TXA in controlling bleeding and preventing rebleeding in acute spontaneous epistaxis.

In this randomized, double-blind, placebo-controlled trial, patients presenting with acute spontaneous epistaxis unresponsive to initial first-aid measures were enrolled and randomly assigned to receive topical tranexamic acid (TXA) or placebo.

A total of 162 patients were included in the study, including 76 in the TXA group and 86 in the control group. Topical TXA was significantly more effective than placebo in achieving initial hemostasis in the emergency department setting (p = 0.047). No significant differences were observed in rebleeding within 24 h (risk ratio 0.45 (95% CI, 0.17-1.24; p = 0.119)), or in significant rebleeding within 24 h (risk ratio: 1.50 (95% CI, 0.26-8.70; p = 0.651)).

In spontaneous epistaxis, the direct application of topical tranexamic acid to the bleeding site is a useful adjunct for achieving hemostasis. This targeted approach may allow effective bleeding control with a smaller amount of the drug, potentially reducing the risk of adverse effects associated with higher doses.