Department of Emergency Medicine, Imam Khomeini Hospital Complex, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Am J Emerg Med. 2013 Sep;31(9):1389-92. doi: 10.1016/j.ajem.2013.06.043. Epub 2013 Jul 30.
Epistaxis is a common problem in the emergency department (ED). Sixty percent of people experience it at least once in their life. There are different kinds of treatment for epistaxis. This study intended to evaluate the topical use of injectable form of tranexamic acid vs anterior nasal packing with pledgets coated with tetracycline ointment.
Topical application of injectable form of tranexamic acid (500 mg in 5 mL) was compared with anterior nasal packing in 216 patients with anterior epistaxis presented to an ED in a randomized clinical trial. The time needed to arrest initial bleeding, hours needed to stay in hospital, and any rebleeding during 24 hours and 1 week later were recorded, and finally, the patient satisfaction was rated by a 0-10 scale.
Within 10 minutes of treatment, bleedings were arrested in 71% of the patients in the tranexamic acid group, compared with 31.2% in the anterior nasal packing group (odds ratio, 2.28; 95% confidence interval, 1.68-3.09; P < .001). In addition, 95.3% in the tranexamic acid group were discharged in 2 hours or less vs 6.4% in the anterior nasal packing group (P < .001). Rebleeding was reported in 4.7% and 11% of patients during first 24 hours in the tranexamic acid and the anterior nasal packing groups, respectively (P = .128). Satisfaction rate was higher in the tranexamic acid compared with the anterior nasal packing group (8.5 ± 1.7 vs 4.4 ± 1.8, P < .001).
Topical application of injectable form of tranexamic acid was better than anterior nasal packing in the initial treatment of idiopathic anterior epistaxis.
鼻出血是急诊科（ED）常见的问题。60%的人一生中至少会经历一次。鼻出血有不同的治疗方法。本研究旨在评估局部应用注射用氨甲环酸与前鼻腔填塞加四环素软膏填塞的疗效。
将 216 例前鼻出血患者随机分为两组，分别接受局部注射用氨甲环酸（500mg 溶于 5ml 中）和前鼻腔填塞治疗。记录首次止血所需时间、住院时间、24 小时和 1 周内的再出血情况，并采用 0-10 分制对患者满意度进行评分。
氨甲环酸组 10 分钟内止血的患者比例为 71%，而前鼻腔填塞组为 31.2%（比值比，2.28；95%置信区间，1.68-3.09；P<0.001）。此外，氨甲环酸组 95.3%的患者在 2 小时内出院，而前鼻腔填塞组仅为 6.4%（P<0.001）。氨甲环酸组和前鼻腔填塞组在 24 小时内再出血的患者比例分别为 4.7%和 11%（P=0.128）。氨甲环酸组的满意度评分（8.5±1.7）明显高于前鼻腔填塞组（4.4±1.8）（P<0.001）。
在特发性前鼻出血的初始治疗中，局部应用注射用氨甲环酸优于前鼻腔填塞。
