Department of Otolaryngology, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, China.
School of Pharmacy, Naval Medical University (Second Military Medical University), Shanghai, China.
Curr Pharm Des. 2023;29(19):1497-1503. doi: 10.2174/1381612829666230214093136.
We aimed to evaluate the effectiveness of topical tranexamic acid (TXA) versus topical vasoconstrictors in the management of epistaxis via a systematic review and meta-analysis.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards were followed for the meta-analysis. We systematically searched Embase, Web of Science, Cochrane Library, CNKI, and PubMed for randomized controlled trials (from inception to August 2022; no language restrictions), comparing the effect of topical TXA and topical vasoconstrictors on the treatment of epistaxis. The Q test was used to evaluate heterogeneity, and funnel plots were utilized to identify bias. For the meta-analysis, the fixedeffects model was employed, and the t-test was utilized to determine significance.
Of 1012 identified studies, 5 were found to be eligible for our analysis. In total, 598 patients were included; 297 of them received TXA and 301 received vasoconstrictors. Hemostasis was more likely to be achieved at the first re-assessment in patients treated with TXA. Subgroup analysis indicated patients treated with TXA to have less likelihood of bleeding recurrence, compared to patients treated with vasoconstrictors. The detected time interval of rebleeding was 10 min, between 24 h to 72 h, and after 7 days, respectively, and the differences were significant between the two groups of patients treated with TXA and vasoconstrictors.
Topical TXA was associated with better post-treatment hemorrhagic arrest rates compared to topical vasoconstrictors in the management of epistaxis.
我们旨在通过系统评价和荟萃分析评估局部氨甲环酸（TXA）与局部血管收缩剂在治疗鼻出血方面的效果。
荟萃分析遵循系统评价和荟萃分析的首选报告项目（PRISMA）标准。我们系统地检索了 Embase、Web of Science、Cochrane 图书馆、中国知网和 PubMed，以查找比较局部 TXA 和局部血管收缩剂治疗鼻出血效果的随机对照试验（从开始到 2022 年 8 月；无语言限制）。使用 Q 检验评估异质性，并使用漏斗图识别偏倚。对于荟萃分析，采用固定效应模型，使用 t 检验确定显著性。
在 1012 项已识别的研究中，有 5 项符合我们的分析标准。共有 598 名患者纳入分析；其中 297 名患者接受 TXA 治疗，301 名患者接受血管收缩剂治疗。在接受 TXA 治疗的患者中，首次重新评估时更容易达到止血效果。亚组分析表明，与接受血管收缩剂治疗的患者相比，接受 TXA 治疗的患者再次出血的可能性较小。检测到的再出血时间间隔分别为 10 分钟、24 小时至 72 小时和 7 天后，两组患者之间的差异均有统计学意义。
与局部血管收缩剂相比，局部 TXA 治疗鼻出血可更好地控制术后出血。
