LAUSR

This is a non-blinded, randomized controlled trial comparing topical TXA and anterior nasal packing in the treatment of anterior epistaxis in patients on antiplatelet medications whose bleeding persisted despite 20 minutes of pressure. Patients were randomized to either TXA (a cotton pledget soaked with 500 mg of TXA and inserted into the affected nostril until hemostasis was achieved) or anterior nasal packing (pretreatment with a cotton pledget soaked in epinephrine and 2% lidocaine for 10 minutes followed by anterior nasal packing with tetracycline ointment left in situ for 3 days). Among the 124 patients included, bleeding at 10 minutes was better controlled in the TXA group (an absolute risk reduction of 44%; 95% CI 26%-57%; p<0.001). The TXA group also had less recurrent bleeding in the first week, a shorter ED length of stay, and higher patient satisfaction. This article is protected by copyright. All rights reserved.