Logan Jill K, Pantle Hardin
Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD.
Department of Emergency Medicine, Johns Hopkins University, Johns Hopkins Bayview Medical Center, Baltimore, MD.
Am J Health Syst Pharm. 2016 Nov 1;73(21):1755-1759. doi: 10.2146/ajhp150829.
The role of topical tranexamic acid in the management of anterior epistaxis in adult patients in the emergency department (ED) is examined.
The use of alternative agents for the treatment of epistaxis before the use of nasal packing may be reasonable due to patient discomfort, potential complications, and the need for follow-up with a healthcare provider for packing removal. One such agent is tranexamic acid. Two published studies evaluated the off-label use of topical tranexamic acid for the treatment of epistaxis. The first trial compared the efficacy of a topical gel containing 10% tranexamic acid with a placebo gel containing glycerin for the treatment of epistaxis. The percentage of patients whose bleeding ceased within 30 minutes of the intervention did not significantly differ between the tranexamic acid and placebo groups (p = 0.16). The second trial compared the efficacy of cotton pledgets soaked in the i.v. formulation of tranexamic acid inserted into the bleeding naris with standard nasal packing therapy. Bleeding cessation occurred within 10 minutes in 71% of the tranexamic acid group versus 31.2% of the standard treatment group (odds ratio, 2.28; 95% confidence interval, 1.68-3.09; p < 0.001). Additional information is necessary to fully evaluate the role of topical tranexamic acid in treatment algorithms; however, the use of topical tranexamic acid may be beneficial in select populations.
Topical tranexamic acid may have a role in the treatment of anterior epistaxis in select ED patients, though additional studies are needed to confirm its role in treatment algorithms.
研究局部应用氨甲环酸在急诊科成年患者鼻出血治疗中的作用。
由于患者不适、潜在并发症以及需要医疗服务提供者随访取出填塞物，在使用鼻腔填塞之前使用替代药物治疗鼻出血可能是合理的。其中一种药物就是氨甲环酸。两项已发表的研究评估了局部应用氨甲环酸治疗鼻出血的超说明书用药情况。第一项试验比较了含10%氨甲环酸的局部凝胶与含甘油的安慰剂凝胶治疗鼻出血的疗效。氨甲环酸组和安慰剂组在干预后30分钟内出血停止的患者百分比无显著差异（p = 0.16）。第二项试验比较了将浸泡过氨甲环酸静脉制剂的棉塞插入出血鼻孔与标准鼻腔填塞治疗的疗效。氨甲环酸组71%的患者在10分钟内出血停止，而标准治疗组为31.2%（优势比，2.28；95%置信区间，1.68 - 3.09；p < 0.001）。需要更多信息来全面评估局部应用氨甲环酸在治疗方案中的作用；然而，在特定人群中使用局部氨甲环酸可能有益。
局部应用氨甲环酸可能在某些急诊科患者鼻出血治疗中发挥作用，不过还需要更多研究来证实其在治疗方案中的作用。
