• Clin Otolaryngol · Dec 2016

    Review

    Tranexamic acid in epistaxis: a systematic review.

    • Y Kamhieh and H Fox.
    • ENT Department, Royal Glamorgan Hospital, Llantrisant, Wales, UK.
    • Clin Otolaryngol. 2016 Dec 1; 41 (6): 771-776.

    BackgroundThe role of tranexamic acid in the management of epistaxis remains unclear. There is uncertainty about its safety and about the contraindications for its use. We performed a systematic review of the use of systemic and topical tranexamic acid in epistaxis and a comparative review of its use in other specialties.Objective Of ReviewThis review assesses and summarises the existing evidence for the efficacy and safety of tranexamic acid in the management of epistaxis.Type Of ReviewSystematic review.Search StrategyMEDLINE and EMBASE were searched for 'epistaxis' and equivalent MESH terms, combined with the Boolean operator 'OR' and 'tranexamic acid'. The Cochrane library and society guidelines were reviewed for evidence regarding the use of tranexamic acid in other specialties.Evaluation MethodAll five relevant RCTs were included in the review and were evaluated according to the recommendations of the Cochrane Handbook for Systematic Reviews.ResultsThree RCTS pertained to spontaneous epistaxis; of these, one trial found no benefit of oral tranexamic acid in acute epistaxis, one trial found no significant benefit of topical tranexamic acid, but the largest of the trials showed significant benefit of topical tranexamic acid in acute epistaxis management. Two RCTs examined oral tranexamic acid for prophylaxis of recurrent epistaxes in patients with hereditary haemorrhagic telangiectasia; both showed significant reduction in severity and frequency.ConclusionsTranexamic acid, as a WHO 'essential medicine', is a powerful, readily available tool, the use of which in epistaxis has been limited by uncertainty over its efficacy and its safety profile. This systematic review summarises the existing evidence and extrapolates from the wealth of data for other specialties to address the clinical question - does TXA have a role in epistaxis management?© 2016 John Wiley & Sons Ltd.

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