{"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":1792409549491,"version":"4.4.0"},"reference-count":53,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,2,27]],"date-time":"2023-02-27T00:00:00Z","timestamp":1677456000000},"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":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The best initial strategy for managing epistaxis is unclear. We performed a systematic review and network meta\u2010analysis (NMA) to compare the effectiveness of various noninvasive treatments for patients with epistaxis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We searched PubMed, Embase, and the Cochrane Library from inception to September 2022 without language restrictions. Randomized controlled trials (RCTs) assessing immediate hemostasis, 2\u2010day and 7\u2010day rebleeding outcomes, as well as the use of noninvasive interventions for the treatment of epistaxis were selected. Frequentist NMA was performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The systematic review included 20 RCTs (2994 participants) involving 12 different interventions. The NMA demonstrated that topical treatment with tranexamic acid (TXA) significantly reduced the odds of 2\u2010day rebleeding compared with the control conservative treatment (odds ratio [OR] 0.36, 95% confidence interval [CI] 0.21\u20130.61) and traditional anterior nasal packing (OR 0.45, 95% CI 0.26\u20130.76). The sensitivity analysis yielded robust results, and the overall evidence was high. Topical TXA significantly reduced the odds of 7\u2010day rebleeding compared with traditional nasal packing (OR 0.33, 95% CI 0.15\u20130.70), with moderate evidence owing to the heterogeneous results. Despite the significant effects of topical TXA on achieving immediate hemostasis and Rapid Rhino nasal packing on preventing 2\u2010day rebleeding compared to the control and traditional nasal packing, the evidence is low to very low due to heterogeneity, inconsistency, and within\u2010study bias.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In the treatment of epistaxis, topical TXA may be superior to conservative treatment or traditional nasal packing, particularly in preventing 2\u2010day rebleeding.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.14680","type":"journal-article","created":{"date-parts":[[2023,2,9]],"date-time":"2023-02-09T13:20:37Z","timestamp":1675948837000},"page":"1047-1058","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Comparative effectiveness of various noninvasive local treatments in patients with epistaxis: A systematic review and network meta\u2010analysis"],"prefix":"10.1111","volume":"30","author":[{"given":"Cheng\u2010Ying","family":"Chiang","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Ditmanson Medical Foundation Chia\u2010Yi Christian Hospital  Chiayi Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jen\u2010Shyang","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Ditmanson Medical Foundation Chia\u2010Yi Christian Hospital  Chiayi Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tou\u2010Yuan","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Dalin Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation  Chiayi Taiwan"},{"name":"School of Medicine Tzu Chi University  Hualien Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu\u2010Kang","family":"Tu","sequence":"additional","affiliation":[{"name":"Institute of Epidemiology and Preventive Medicine, College of Public Health National Taiwan University  Taipei Taiwan"},{"name":"Department of Dentistry, National Taiwan University Hospital and School of Dentistry National Taiwan University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2662-1206","authenticated-orcid":false,"given":"Ming\u2010Jen","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Ditmanson Medical Foundation Chia\u2010Yi Christian Hospital  Chiayi Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,2,27]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599816667295"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2004.12.014"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1308\/003588412X13373405386691"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp2019344"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.14639\/0392-100X-2155"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599819890327"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2013.5220"},{"issue":"12","key":"e_1_2_9_9_1","article-title":"Tranexamic acid for patients with nasal haemorrhage (epistaxis)","volume":"2018","author":"Joseph J","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2019.11.038"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2020.12.013"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2022.04.010"},{"issue":"1","key":"e_1_2_9_13_1","article-title":"Topical tranexamic acid versus phenylephrine\u2010lidocaine for the treatment of anterior epistaxis in patients taking aspirin or clopidogrel; 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