Intranasal TXA for Anterior Epistaxis in the Emergency Department

Mercy Health Ohio86 enrolled

Overview

The objective of this study is to evaluate the efficacy of and patient satisfaction with the use of intranasal tranexamic acid (TXA) for anterior nosebleeds in the emergency department (ED).

Pledget soaked in either saline or TXA will be applied to the bleeding nare of the patient presenting with anterior epistaxis. After fifteen minutes, the pledget will be removed and patient reassessed. Informed consent will be obtained prior to patient enrollment. Enrolled patients will be placed in one of two groups: either the group receiving a cotton pledget soaked in (0.9%) saline or (100mg/1mL) TXA. Patients will initially be asked to gently blow their nose to remove any clots. Group 1 will receive the saline soaked pledget. After fifteen minutes the pledget will be removed. If patient continues to bleed within a reevaluation period of fifteen minutes, this will be deemed a 'failure' and the examiner will pack the nose with the method of his or her choice. Group 2 will receive the TXA soaked pledget and the procedure will continue like Group 1. Patient satisfaction will be assessed in both groups during ED stay and one week after ED stay.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

Epistaxis

Interventions

Tranexamic AcidDRUG

Enrolled patients will be placed in one of two groups: either the group receiving a cotton pledget soaked in (0.9%) saline or (100mg/1mL) TXA. Patients will initially be asked to gently blow their nose to remove any clots. Group 1 will receive the saline soaked pledget. After fifteen minutes the pledget will be removed. If patient continues to bleed within a reevaluation period of fifteen minutes, this will be deemed a 'failure' and the examiner will pack the nose with the method of his or her choice. Group 2 will receive the TXA soaked pledget and the procedure will continue like Group 1.

PlaceboOTHER

This group will receive pledget soaked in saline. Protocol will continue as with TXA group.

Eligibility

Sex: ALLMin age: 18 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion criteria: • Patients 18 years and older with anterior epistaxis Exclusion criteria: * Patients with inability to give consent * Patients without a working telephone number * Patients lacking the mental capacity to make their own decisions * Patients with posterior epistaxis * Epistaxis following major trauma * Patients with known bleeding disorder like hemophilia and thrombocytopenia * Prisoners * Patients hemodynamically unstable * Pregnant patients * Patients with a known allergy to TXA * Patients with a visibly bleeding vessel * Those recently post-op nasal/sinus surgery (within ten days) will also be excluded

Locations (2)

St Elizabeth Boardman Hospital

Boardman, Ohio, United States

St Elizabeth Youngstown

Youngstown, Ohio, United States

Outcomes

Primary Outcomes

Bleeding cessation

After 15 minutes of patient receiving either pledget filled TXA or placebo, bleeding will be assessed

Time frame: 15 minutes

Secondary Outcomes

Patient satisfaction: 10 point scale

Patient satisfaction will be assessed at the end of the emergency department encounter, and then again via telephone call one week after discharge using a 10 point scale

Time frame: Before ED discharge (up to 24 hours) and 1 week after ED discharge

Bleeding cessation

Patients will be contacted 1 week after ED discharge to determine whether there was a recurrence of his/her epistaxis

Time frame: 1 week

Data from ClinicalTrials.gov

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