Efficacy of Topical Xylometazoline Versus Topical Tranexamic Acid In The Treatment Of Anterior Epistaxis

Abstract

Objective: The objective of this study was to compare the efficacy of topical xylometazoline and topical tranexamic acid in achieving bleeding control in patients presenting with anterior epistaxis in the emergency department.

Method: After getting approval from the ethical review board, this RCT was conducted at Rawalpindi Teaching Hospital from 2^nd February 2024 to 1^st February 2025. A total of 80 patients (more than 18 years of age) with spontaneous anterior epistaxis were included in the study using non-probability consecutive sampling. They were randomly assigned to two equal groups (n = 40 each). One group received topical xylometazoline (0.1%), which was put on a cotton pledget and inserted into the affected nostril, while the other group received topical tranexamic acid (500 mg in 5 mL) using the same technique. The pledgets remained in place for 10 minutes. The primary outcome was to note the time to achieve haemostasis, which was categorised into 4 intervals: 5-10 minutes, 11-20 minutes, 21-30 minutes, or more than 30 minutes. If the bleeding had not stopped within 30 minutes, it would mean treatment failure, and the patient would be managed via cautery or nasal packing. The secondary outcome was to note the incidence of rebleeding within 48 hours.

Results: In the tranexamic acid group, 45% of patients achieved haemostasis within 5–10 minutes, while only 23% of patients achieved haemostasis in the xylometazoline group in the same period, indicating a statistically significant difference (p = 0.019). An additional 45% of the patients in the tranexamic acid group achieved haemostasis within 11–20 minutes, whereas only 18% in the xylometazoline group stopped bleeding within the same timeframe. In the 21–30-minute category, 15% of the patients treated with tranexamic acid achieved haemostasis compared to 25% in the xylometazoline group. For the secondary outcome of rebleeding within 8 hours,43% of patients in the tranexamic acid group experienced recurrence of bleeding, compared to 50% in the xylometazoline group (p = 0.23).

Conclusion: These findings suggest that Topical tranexamic acid is significantly more effective in achieving rapid haemostasis compared to xylometazoline and is associated with a lower failure rate. However, both agents exhibit similar rebleeding rates within 48 hours.

Keywords: Epistaxis; Tranexamic acid; Administration, Topical; Hemostasis; Vasoconstrictor agents; Antifibrinolytic agents