{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T11:32:29Z","timestamp":1792409549025,"version":"4.4.0"},"reference-count":25,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2017,12,9]],"date-time":"2017-12-09T00:00:00Z","timestamp":1512777600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>We evaluated the efficacy of topical application of the injectable form of tranexamic acid (<jats:styled-content style=\"fixed-case\">TXA<\/jats:styled-content>) compared with anterior nasal packing (<jats:styled-content style=\"fixed-case\">ANP<\/jats:styled-content>) for the treatment of epistaxis in patients taking antiplatelet drugs (aspirin, clopidogrel, or both) who presented to the emergency department (<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A randomized, parallel\u2010group clinical trial was conducted at two <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>s. A total of 124 participants were randomized to receive topical <jats:styled-content style=\"fixed-case\">TXA<\/jats:styled-content> (500 mg in 5\u00a0<jats:styled-content style=\"fixed-case\">mL<\/jats:styled-content>) or <jats:styled-content style=\"fixed-case\">ANP<\/jats:styled-content>, 62 patients per group. The primary outcome was the proportion of patients in each group whose bleeding had stopped at 10 minutes. Secondary outcomes were the rebleeding rate at 24 hours and 1 week, <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> length of stay (<jats:styled-content style=\"fixed-case\">LOS<\/jats:styled-content>), and patient satisfaction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Within 10 minutes of treatment, bleeding was stopped in 73% of the patients in the <jats:styled-content style=\"fixed-case\">TXA<\/jats:styled-content> group, compared with 29% in the <jats:styled-content style=\"fixed-case\">ANP<\/jats:styled-content> group (difference\u00a0= 44%, 95% confidence interval, 26% to 57%; p\u00a0&lt;\u00a00.001). Additionally, rebleeding was reported in 5 and 10% of patients during the first 24 hours in the <jats:styled-content style=\"fixed-case\">TXA<\/jats:styled-content> and the <jats:styled-content style=\"fixed-case\">ANP<\/jats:styled-content> groups, respectively. At 1 week, 5% of patients in the <jats:styled-content style=\"fixed-case\">TXA<\/jats:styled-content> group and 21% of patients in the <jats:styled-content style=\"fixed-case\">ANP<\/jats:styled-content> group had experienced recurrent bleeding (p\u00a0=\u00a00.007). Patients in the <jats:styled-content style=\"fixed-case\">TXA<\/jats:styled-content> group reported higher satisfaction scores (median [interquartile range {<jats:styled-content style=\"fixed-case\">IQR<\/jats:styled-content>}], 9 [8\u20139.25]) compared with the <jats:styled-content style=\"fixed-case\">ANP<\/jats:styled-content> group (median [<jats:styled-content style=\"fixed-case\">IQR<\/jats:styled-content>]\u00a0= 4 [3\u20135]; p\u00a0&lt;\u00a00.001). Discharge from the <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> in\u00a0&lt;2 hours was achieved in 97% of patients in the <jats:styled-content style=\"fixed-case\">TXA<\/jats:styled-content> group versus 13% in the <jats:styled-content style=\"fixed-case\">ANP<\/jats:styled-content> group (p\u00a0&lt;\u00a00.001). There were no adverse events reported in either group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In our study population, epistaxis treatment with topical application of <jats:styled-content style=\"fixed-case\">TXA<\/jats:styled-content> resulted in faster bleeding cessation, less rebleeding at 1\u00a0week, shorter <jats:styled-content style=\"fixed-case\">ED LOS<\/jats:styled-content>, and higher patient satisfaction compared with <jats:styled-content style=\"fixed-case\">ANP<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.13345","type":"journal-article","created":{"date-parts":[[2017,11,10]],"date-time":"2017-11-10T16:16:43Z","timestamp":1510330603000},"page":"261-266","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":63,"title":["Topical Tranexamic Acid Compared With Anterior Nasal Packing for Treatment of Epistaxis in Patients Taking Antiplatelet Drugs: Randomized Controlled Trial"],"prefix":"10.1111","volume":"25","author":[{"given":"Reza","family":"Zahed","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Imam Khomeini Hospital Complex Faculty of Medicine Tehran University of Medical Sciences Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Hossain","family":"Mousavi Jazayeri","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Tehran University of Medical Sciences Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asieh","family":"Naderi","sequence":"additional","affiliation":[{"name":"Eye Research Center Farabi Eye Hospital Tehran University of Medical Sciences Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeinab","family":"Naderpour","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Tehran University of Medical Sciences Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morteza","family":"Saeedi","sequence":"additional","affiliation":[{"name":"Emergency Medicine Research Center Department of Emergency Medicine Shariati Hospital Faculty of Medicine Tehran University of Medical Sciences Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,12,9]]},"reference":[{"key":"e_1_2_8_2_1","article-title":"The aetiology and management of epistaxis","volume":"6","author":"Tikka T.","year":"2016","journal-title":"Otolaryngol Online J"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40463-016-0138-2"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215110001921"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215113000492"},{"key":"e_1_2_8_6_1","first-page":"817","article-title":"Epistaxis as the reason for premature discontinuation of clopidogrel after percutaneous coronary angioplasty with stent implantation","volume":"69","author":"Jura\u2010Szo\u0142tys E","year":"2011","journal-title":"Kardiol Polska (Polish Heart J)"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12070-011-0343-2"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2013.06.043"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.4317\/medoral.20510"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2009.02.004"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajr.2007.21.3097"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0104477"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2013.04.021"},{"key":"e_1_2_8_14_1","unstructured":"Population and Household by Province and Shahrestan.2017. 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