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Epistaxis

Date Last Search Run: Feb 01, 2022
Table last updated: Feb 23, 2022
Data last added: Mar 30, 2022

Recommendation RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION   SUPPORTIVE (Green) NEUTRAL (Yellow) AGAINST (Red) NOT YET GRADED (White)
1 (strong evidence exists)    
2 (fair evidence exists)    
3 (weak evidence exists)      


Interventions

Anterior nasal packing
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Success rate (stopping bleeding) within 15 minutes Patient ED-MD Akkan S, Çorbacıoğlu ŞK, Aytar H, Emektar E, Dağar S, Çevik Y. Evaluating Effectiveness of Nasal Compression With Tranexamic Acid Compared With Simple Nasal Compression and Merocel Packing: A Randomized Controlled Trial. Ann Emerg Med. 2019 Jul;74(1):72-78. doi: 10.1016/j.annemergmed.2019.03.030. Epub 2019 May 9. PMID: 31080025. Medline
I Supportive (Green) Pain on insertion Patient ED-MD Singer AJ., Blanda M., Cronin K., et al. Comparison of nasal tampons for the treatment of epistaxis in the emergency department: A randomized controlled trial. Ann Emerg Med. 2005; 45(2):134-139. Medline
I Supportive (Green) Time to Hemostasis Patient ED-MD Zahed R., Moharamzadeh P., Alizadeharasi S., Ghasemi A., Saeedi M. A new and rapid method for epistaxis treatment using injectable form of tranexamic acid topically: A randomized controlled trial. Am J Emerg Med 2013; 31(9):1389-1392. Medline
II Supportive (Green) Treatment success/failure rates Patient Newton E., Lasso A., Petrcich W., Kilty SJ. An outcomes analysis of anterior epistaxis management in the emergency department. Journal of Otolaryngology - Head & Neck Surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 2016; 45:24. Medline
II Supportive (Green) Cessation of hemorrhage Patient PH-Paramedic Te GR, van GP, Heutz WMJM., Tan ECTH. Use of Hemostatic Nasal Plugs in Emergency Medical Services in the Netherlands A Prospective Study of 33 Cases. PEC; 22(1) 91-8. Medline
II Neutral (Yellow) Requirement for further treatment Process In-Patient Evans AS., Young D., Adamson R. Is the nasal tampon a suitable treatment for epistaxis in accident & emergency? A comparison of outcomes for ENT and A&E packed patients. J Laryngol Otol 2004; 118(1):12-4. Medline
II Neutral (Yellow) Disposition (admission vs discharge) Patient ED-MD Upile T., Jerjes W., Sipaul F., et al. A change in UK epistaxis management. Eur Arch Otorhinolaryngol 2008; 265(11):1349-1354. Medline
III Supportive (Green) Efficacy Process In-Patient Corbridge RJ., Djazaer B., Hellier WPL., Hadley J. A prospective randomized controlled trial comparing the use of merocel nasal tampons and BIPP in the control of acute epistaxis. Clin Oto 1995; 20:305-7. Medline

Pressure
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) Treatment success/failure rates Patient Newton E., Lasso A., Petrcich W., Kilty SJ. An outcomes analysis of anterior epistaxis management in the emergency department. Journal of Otolaryngology - Head & Neck Surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 2016; 45:24. Medline
X Not Yet Graded (White) - Akkan S, Çorbacıoğlu ŞK, Aytar H, Emektar E, Dağar S, Çevik Y. Evaluating Effectiveness of Nasal Compression With Tranexamic Acid Compared With Simple Nasal Compression and Merocel Packing: A Randomized Controlled Trial. Ann Emerg Med. 2019 Jul;74(1):72-78. doi: 10.1016/j.annemergmed.2019.03.030. Epub 2019 May 9. PMID: 31080025. Medline

Seated leaned forward
Level Direction Primary Outcome Patient/Process Setting Reference

Topical TXA
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Hemostasis Patient ED-MD Akkan S, Çorbacıoğlu ŞK, Aytar H, Emektar E, Dağar S, Çevik Y. Evaluating Effectiveness of Nasal Compression With Tranexamic Acid Compared With Simple Nasal Compression and Merocel Packing: A Randomized Controlled Trial. Ann Emerg Med. 2019 Jul;74(1):72-78. doi: 10.1016/j.annemergmed.2019.03.030. Epub 2019 May 9. PMID: 31080025. Medline
I Supportive (Green) Time to treatment effect Process ED-MD Gottlieb M, DeMott JM, Peksa GD. Topical Tranexamic Acid for the Treatment of Acute Epistaxis: A Systematic Review and Meta-analysis. Ann Pharmacother. 2019 Jun;53(6):652-657. doi: 10.1177/1060028018820625. Epub 2018 Dec 21. PMID: 30577703. Medline
I Supportive (Green) Control of bleeding Patient ED-MD Joseph J, Martinez-Devesa P, Bellorini J, Burton MJ. Tranexamic acid for patients with nasal haemorrhage (epistaxis). Cochrane Database Syst Rev. 2018 Dec 31;12(12):CD004328. doi: 10.1002/14651858.CD004328.pub3. PMID: 30596479; PMCID: PMC6517002. Medline
I Supportive (Green) Need for blood transfusion Patient ED-MD Montroy J, Hutton B, Moodley P, Fergusson NA, Cheng W, Tinmouth A, Lavallée LT, Fergusson DA, Breau RH.The efficacy and safety of topical tranexamic acid: A systematic review and meta-analysis. Transfus Med Rev. 2018 [Epub ahead of print] Medline
I Supportive (Green) Time to Hemostasis Patient ED-MD Zahed R., Moharamzadeh P., Alizadeharasi S., Ghasemi A., Saeedi M. A new and rapid method for epistaxis treatment using injectable form of tranexamic acid topically: A randomized controlled trial. Am J Emerg Med 2013; 31(9):1389-1392. Medline
II Neutral (Yellow) Need for packing Process ED-MD Reuben A, Appelboam A, Stevens KN, Vickery J, Ewings P, Ingram W, Jeffery AN, Body R, Hilton M, Coppell J, Wainman B, Barton A. The Use of Tranexamic Acid to Reduce the Need for Nasal Packing in Epistaxis (NoPAC): Randomized Controlled Trial. Ann Emerg Med. 2021 Jun;77(6):631-640. doi: 10.1016/j.annemergmed.2020.12.013. Epub 2021 Feb 19. PMID: 33612282. Medline
III Supportive (Green) Bleeding cessation Patient ED-MD Hassen GW., Clemons P., Kaplun M., Kalantari H. Is topical tranexamic acid a better alternative for selected cases of anterior epistaxis management in the ED? Am J Emerg Med 2018; 36(4) 734.e1-2. Medline


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