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
|
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
|
Supportive (Green)
|
Admission
|
Process
|
ED-MD
|
Rosario E, Sharma E, Patel A, et al. Use of tranexamic acid-soaked NasoPore® in the emergency department, to reduce epistaxis admissions. Clin Otolaryngol Nov 2023; 48(6):909-14. 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
|