Abstract
Title: Assessment of Anterior Epistaxis Management in an Adult Emergency Department
Significance: Previous studies have shown mixed results that tranexamic acid reduces time to bleeding cessation, with variation in route, dose, and application method. Utilizing tranexamic acid before nasal packing or balloons can speed up discharge from the emergency department and reduce the admission rate, leading to cost savings, patient satisfaction, and reduced resource utilization.
Purpose: The primary objective was to evaluate the impact of topical tranexamic acid on achieving hemostasis in adult patients with anterior epistaxis. The study also assessed current documentation practices for epistaxis severity to identify opportunities for standardizing management and treatment sequencing.
Methods: This single-center, retrospective quality improvement initiative was conducted at Baptist Hospital of Miami. Data were collected from October 2023 through July 2025 for adult patients (≥18 years) presenting to the emergency department for the treatment of anterior epistaxis. Outcomes for topical tranexamic acid were compared to site-specific standard management, including the use of vasoconstrictors (0.05% oxymetazoline, 0.5% phenylephrine hydrochloride, epinephrine, 4% cocaine), cautery with silver nitrate, and nasal packing or balloons. The primary outcome compared hemostasis rates between patients treated with and without topical tranexamic acid. Secondary outcomes included evaluating topical tranexamic acid as salvage therapy, quantifying the total number of agents required for bleeding cessation, and assessing epistaxis severity.
Results: A total of 87 patients were included in the review. Topical tranexamic acid demonstrated an 87% hemostasis rate compared to 70% with standard therapies. For severe epistaxis, topical tranexamic acid achieved hemostasis in 7 patients versus 2 in the standard care group. In cases requiring three or more agents, the utilization of topical tranexamic acid as salvage therapy resulted in an increase of hemostasis success rate.
Discussion: Findings support utilization of topical tranexamic acid into emergency department practice to optimize hemostasis rates. Next steps include developing a standardized epistaxis management guidance and a bleeding severity grading scale to guide treatment and enhance electronic health record documentation. Future initiatives will focus on provider education regarding severity assessment and the precise documentation of treatment timing and sequences.
Publication Date
Winter 12-10-2025
Presented At:
Midyear Clinical Meeting and Exhibition (ASHP)
Content Type
Poster
Citation
Lanzas, Erwin; Harding, Jeanna; Bueno, Stephen; Wolfel, Tom; and Dittmar, Erika, "Assessment of Anterior Epistaxis Management in an Adult Emergency Department" (2025). All Publications. 6240.
https://scholarlycommons.baptisthealth.net/se-all-publications/6240
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