Epistaxis Management

Introduction to Tranexamic Acid

The American Academy of Otolaryngology-Head and Neck Surgery recommends topical tranexamic acid as an effective treatment for active epistaxis, with a suggested initial dose of 500-1000 mg applied topically to the nasal cavity 1
Topical application of 1000 mg of tranexamic acid is considered a first-line treatment for active bleeding, with a high success rate of bleeding cessation within 10 minutes 1
The American Academy of Otolaryngology-Head and Neck Surgery suggests applying topical vasoconstrictors, such as oxymetazoline, as a first-line treatment to control active bleeding, followed by topical tranexamic acid 1000 mg as a second-line treatment 1

The recommended starting dose for oral tranexamic acid in patients with recurrent epistaxis is 500 mg twice daily, with possible dose titration up to 1000 mg four times daily or 1500 mg three times daily (maximum 4000 mg/day) 2
Absolute contraindications for oral tranexamic acid include recent thrombosis, and relative contraindications include atrial fibrillation, and known thrombophilia, according to the Blood journal 2
Monitoring for potential thrombotic events is necessary, although rare with topical application, as stated by the Blood journal 2

Topical tranexamic acid has advantages over nasal packing, including faster bleeding control, shorter emergency department stay, and lower rebleeding rates at 1 week, as reported in the Otolaryngology--head and neck surgery journal 1
For patients taking antiplatelet drugs, such as aspirin or clopidogrel, topical tranexamic acid remains highly effective in achieving bleeding cessation within 10 minutes and reducing rebleeding rates at 1 week compared to anterior nasal packing 1