Royal Devon and Exeter NHS Foundation Trust, Exeter, England.
Royal Devon and Exeter NHS Foundation Trust, Exeter, England.
Ann Emerg Med. 2021 Jun;77(6):631-640. doi: 10.1016/j.annemergmed.2020.12.013. Epub 2021 Feb 19.
Epistaxis is a common emergency department (ED) presentation and, if simple first aid measures fail, can lead to a need for anterior nasal packing. Tranexamic acid is an agent that contributes to blood clot stability. The aim of this study is to investigate the effectiveness of topical intranasal tranexamic acid in adult patients presenting to the ED with persistent epistaxis, and whether it reduces the need for anterior nasal packing.
From May 5, 2017, to March 31, 2019, a double-blind, placebo-controlled, multicenter, 1:1, randomized controlled trial was conducted across 26 EDs in the United Kingdom. Participants with spontaneous epistaxis, persisting after simple first aid and the application of a topical vasoconstrictor, were randomly allocated to receive topical tranexamic acid or placebo. The primary outcome was the need for anterior nasal packing of any kind during the index ED attendance. Secondary outcome measures included hospital admission, need for blood transfusion, recurrent epistaxis, and any thrombotic events requiring any hospital reattendance within 1 week.
The study sample consisted of 496 participants with spontaneous epistaxis, persisting after simple first aid and application of a topical vasoconstrictor. In total, 211 participants (42.5%) received anterior nasal packing during the index ED attendance, including 111 of 254 (43.7%) in the tranexamic acid group versus 100 of 242 (41.3%) in the placebo group. The difference was not statistically significant (odds ratio 1.107; 95% confidence interval 0.769 to 1.594; P=.59). Furthermore, there were no statistically significant differences between tranexamic acid and placebo for any of the secondary outcome measures.
In patients presenting to an ED with atraumatic epistaxis that is uncontrolled with simple first aid measures, topical tranexamic acid applied in the bleeding nostril on a cotton wool dental roll is no more effective than placebo at controlling bleeding and reducing the need for anterior nasal packing.
鼻出血是急诊科常见的就诊原因，如果简单的急救措施失败，可能需要进行前鼻孔填塞。氨甲环酸是一种有助于稳定血凝块的药物。本研究旨在调查局部鼻腔内使用氨甲环酸治疗急诊科就诊的持续性鼻出血成人患者的效果，以及是否能减少前鼻孔填塞的需要。
2017 年 5 月 5 日至 2019 年 3 月 31 日，在英国的 26 个急诊科进行了一项双盲、安慰剂对照、多中心、1:1 随机对照试验。患有自发性鼻出血的患者，在简单急救和应用局部血管收缩剂后仍持续出血，被随机分配接受局部氨甲环酸或安慰剂治疗。主要结局是在就诊期间需要进行任何类型的前鼻孔填塞。次要结局指标包括住院、需要输血、再次鼻出血以及在 1 周内任何需要再次入院的血栓形成事件。
研究样本包括 496 名自发性鼻出血患者，在简单急救和应用局部血管收缩剂后仍持续出血。在就诊期间，共有 211 名患者（42.5%）需要进行前鼻孔填塞，其中氨甲环酸组 254 名患者中有 111 名（43.7%），安慰剂组 242 名患者中有 100 名（41.3%）。差异无统计学意义（比值比 1.107；95%置信区间 0.769 至 1.594；P=.59）。此外，在任何次要结局指标方面，氨甲环酸与安慰剂之间均无统计学差异。
在急诊科就诊的非创伤性鼻出血患者中，如果简单的急救措施无法控制出血，在前鼻孔出血侧鼻腔内使用涂有氨甲环酸的药棉卷进行局部应用，与安慰剂相比，在控制出血和减少前鼻孔填塞的需要方面并无优势。
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