Topical tranexamic acid compared with anterior nasal packing treatment of epistaxis in patients taking antiplatelet drugs.

Objective: To evaluate the effectiveness of anterior nasal packing and topical tranexamic acid in treating epistaxis in patients on antiplatelet medications. Study Design: Randomized Controlled Trail. Setting: Emergency Department of Ziauddin University Hospital, Karachi. Period: 21-5-2024 to 5-5-2025. Methods: Those patients who presented with anterior epistaxis were randomised by using the lottery method to receive anterior nasal packing (ANP) or topical application of tranexamic acid (TXA), with 30 patients in each group. In the case group, patients were treated with topical tranexamic acid, while in the control group, patients were treated with ANP. The Statistical Package for Social Sciences (SPSS version 25) was utilized for interpretation of collected data. Results: Of the 60 epistaxis patients, majority of epistaxis patients were male (55.0%, n=33), and the remaining were female (45.0%, n=27), with an average age of 59.2 ± 8.3 years. Mean cessation time of bleeding in epistaxis patients was 7.1 ± 3.4 min in the case (TXA) group and 13.4 ± 4.9 min in the control (ANP) group (p-value < 0.001). Length of stay in ED in epistaxis patients was significantly lower in the case (TXA) group as compared to the control (ANP) group (p-value=0.042). Rebleeding in epistaxis patients occurred in 10.0% (n=3) in the case (TXA) group and 40.0% (n=12) in the control (ANP) group (p-value=0.007). Treatment in epistaxis patients was satisfactory in 90.0% (n=27) in the case (TXA) group and 66.7% (n=20) in the control (ANP) group (p-value=0.028). Conclusion: The use of topical tranexamic acid instead of anterior nasal packing for the treatment of epistaxis in patients who were on antiplatelet drugs is associated with significantly shorter duration of bleeding control, fewer rebleeding episodes, decreased length of ED stay, and greater satisfaction.