Premium
Tranexamic acid in epistaxis: a systematic review
Author(s) -
Kamhieh Y.,
Fox H.
Publication year - 2016
Publication title -
clinical otolaryngology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.914
H-Index - 68
eISSN - 1749-4486
pISSN - 1749-4478
DOI - 10.1111/coa.12645
Subject(s) - tranexamic acid , medicine , randomized controlled trial , cochrane library , systematic review , medline , clinical trial , surgery , blood loss , political science , law
Background The 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 review This review assesses and summarises the existing evidence for the efficacy and safety of tranexamic acid in the management of epistaxis. Type of review Systematic review. Search strategy MEDLINE 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 method All five relevant RCT s were included in the review and were evaluated according to the recommendations of the Cochrane Handbook for Systematic Reviews. Results Three 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 RCT s examined oral tranexamic acid for prophylaxis of recurrent epistaxes in patients with hereditary haemorrhagic telangiectasia; both showed significant reduction in severity and frequency. Conclusions Tranexamic 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?