EFFICACY OF TOPICAL TRANEXAMIC ACID COMPARED WITH TOPICAL XYLOMETAZOLINE IN MANAGEMENT OF PATIENT WITH EPISTAXIS TAKING ANTIPLATELET DRUGS.

Abstract

Background: Epistaxis is a frequent emergency room presentation, with a significant portion of cases requiring active medical intervention. While anterior nasal packing remains a conventional approach, newer pharmacological options like topical tranexamic acid (TXA) have gained attention due to their antifibrinolytic action. Xylometazoline, a topical decongestant with vasoconstrictive properties, is commonly used in emergency settings for anterior epistaxis, yet comparative data between the two agents remain limited.

Objective: To compare the efficacy of topical application of intravenous TXA with topical xylometazoline in achieving hemostasis in patients presenting with anterior epistaxis who are on antiplatelet therapy.

Methods: This prospective randomized controlled trial was conducted at the Emergency Department of the Pakistan Institute of Medical Sciences, Islamabad, from December 2023 to November 2024. A total of 88 patients, aged 13–60 years, using antiplatelet medications and presenting with anterior epistaxis were enrolled. Patients were randomized into two groups (n=44 each). Group A received 100 mg/mL of intravenous TXA applied topically via nasal spray. Group B received 2–3 puffs of 0.1% xylometazoline spray in each nostril. Hemostasis was assessed at 30 minutes post-administration. SPSS version 25.0 was used for statistical analysis, and chi-square test determined significance at p<0.05.

Results: The mean age was 47.3 ± 7.4 years in Group A and 45.3 ± 8.6 years in Group B (p=0.846). Group A comprised 26 males (59%) and 18 females (41%), while Group B had 28 males (63.63%) and 16 females (36.36%) (p=0.568). Hemostasis at 30 minutes was achieved in 10 patients (22.73%) in Group A and 29 patients (65.91%) in Group B, showing a statistically significant difference (p<0.001).

Conclusion: Topical xylometazoline demonstrated significantly higher efficacy compared to intravenous TXA preparation in achieving hemostasis for anterior epistaxis in patients on antiplatelet therapy, supporting its role as a first-line intervention in emergency care.