Stopping the Drip: Tranexamic Acid for Nosebleeds
- The Review Course in Family Medicine
- Nov 15
- 1 min read
Thinking Tx for Expistaxis? Think TXA! Topical tranexamic acid (TXA) is an effective treatment for epistaxis. Applied via cotton pledget, TXA significantly increases hemostasis within 10 minutes—82% success vs. 55% with saline in one RCT. It may also outperform vasoconstrictors: 90% success vs. 14% for phenylephrine-lidocaine in patients on antiplatelet therapy.
Beyond TXA as an option on the exam, why not stock a vial for your clinic?*
TXA reduces 24-hour rebleeding (6% vs. 29%) and shortens bleeding duration. While combining TXA with vasoconstrictors shows mixed results for initial control, it may reduce rebleeding. TXA performs as well or better than nasal packing, with similar side effect profiles.
Evidence in children is limited, but for most adults—especially those on antiplatelet therapy—TXA is a safe, effective first-line option for anterior epistaxis.
*We have no disclosures or funding from Big TXA... we just think this evidence is very compelling!
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