Paperchase 2 - Epistaxis Treatment with Tranexamic Acid

Sign in or subscribe to listen

No me gusta!

The flash player was unable to start. If you have a flash blocker then try unblocking the flash content - it should be visible below.

Jose Diaz PA-C -

Two tongue blades taped together -> best nose clips, ever!

Paul T. MBChB -

Any data on PO TXA? eg Cauterize in the standard way and discharge on 1.5g tid PO TXA for 7d to prevent recurrence.

francesco m. -

I have wondered if this was ever an option. It sounds reasonable. Is there a specific quantity or max dose that is suggested.

Jennifer M. -

This sounds great. But can you just insert thrombin instead? Just another thought.

Brad N. -

The study referenced used 500mg total TXA soaked into cotton pledgets. I've started doing this over the last 6 months and it has worked for 5 out of 6 bleeds. I don't think it is useful for those with so much bleeding that you can't slow it down...those people just need compressive packing (e.g. Rhino-rockets). I order 1000mg (10mL) TXA from pharmacy in a syringe. I soak the cotton pledgets with around 5mL (500mg). I then atomize around 1mL in the affected nostril then place the pledgets. So far it has worked well for those non-hemorrhaging pesky bleeders without any obvious thrombotic complications in my small sample size.

Suzanne M., Dr -

We've been atomising 500mg into the bleeding nostril and clamping with a good home made tongue depressor peg and waiting for 20 minutes. So far so good, sample size only 5 though.

Sean G., M.D. -

anterior nose bleeds.....I pack em all cause the reason they occurred is the patient was digging at their septum, and the reason cautery never works is when they leave they commence to digging again. The packing simply blocks the offending finger from the wound site for long enough for it to heal....

Tasha B. -

agree with Sean's easy, it's quick, it works and avoids them digging after they leave !!!!

Andrew SAQ, M.D. -

For the tongue depressors to work it has to exert sufficient force, so tape six depressors together and tape it 2/3 away from the nose. I also instruct the patient to apply some additional pressure by gently pinching to stabilize the device.

Leslie S. -

Remember that CRASH-2 and the MATTERS trial did not show an increases in clot formation with TXA. It is an anti-fibrinolytic not a pro-coagulant (like factor 7a) and probably does NOT have an increase thrombotic risk (I think your comments are misleading)

James C. -

For those trying this, are you
1) Still having them blow out the clots first?
2) Cauterizing first?

To join the conversation, you need to subscribe.

Sign up today for full access to all episodes and to join the conversation.