Evaluating Effectiveness of Nasal Compression With Tranexamic Acid Compared With Simple Nasal Compression and Merocel Packing: A Randomized Controlled Trial

Ann Emerg Med. 2019 Jul;74(1):72-78. doi: 10.1016/j.annemergmed.2019.03.030. Epub 2019 May 9.


Study objective: The primary objective of this study is to compare the effectiveness of 3 treatment protocols to stop anterior epistaxis: classic compression, nasal packing, and local application of tranexamic acid. It also aims to determine the frequency of rebleeding after each of these protocols.

Methods: This single-center, prospective, randomized controlled study was conducted with patients who had spontaneous anterior epistaxis. The study compared the effect of 3 treatment options, tranexamic acid with compression but without nasal packing, nasal packing (Merocel), and simple nasal external compression, on the primary outcome of stopping anterior epistaxis bleeding within 15 minutes.

Results: Among the 135 patients enrolled, the median age was 60 years (interquartile range 25% to 75%: 48 to 72 years) and 70 patients (51.9%) were women. The success rate in the compression with tranexamic acid group was 91.1% (41 of 45 patients); in the nasal packing group, 93.3% (42 of 45 patients); and in the compression with saline solution group, 71.1% (32 of 45 patients). There was an overall statistically significant difference among the 3 treatment groups but no significant difference in pairwise comparison between the compression with tranexamic acid and nasal packing groups. In regard to no rebleeding within 24 hours, the study found rates of 86.7% in the tranexamic acid group, 74% in the nasal packing group, and 60% in the compression with saline solution group.

Conclusion: Applying external compression after administering tranexamic acid through the nostrils by atomizer stops bleeding as effectively as anterior nasal packing using Merocel. In addition, the tranexamic acid approach is superior to Merocel in terms of decreasing rebleeding rates.

Trial registration: ClinicalTrials.gov NCT03360045.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Antifibrinolytic Agents / administration & dosage*
  • Antifibrinolytic Agents / therapeutic use
  • Epistaxis / drug therapy*
  • Female
  • Formaldehyde / administration & dosage
  • Formaldehyde / therapeutic use
  • Hemostatics / administration & dosage
  • Hemostatics / therapeutic use
  • Humans
  • Male
  • Middle Aged
  • Nose / blood supply
  • Nose / drug effects
  • Nose / pathology*
  • Polyvinyl Alcohol / administration & dosage
  • Polyvinyl Alcohol / therapeutic use
  • Prospective Studies
  • Tampons, Surgical / adverse effects
  • Tampons, Surgical / standards
  • Tranexamic Acid / administration & dosage*
  • Tranexamic Acid / therapeutic use


  • Antifibrinolytic Agents
  • Hemostatics
  • Formaldehyde
  • polyvinyl alcohol formaldehyde foam
  • Tranexamic Acid
  • Polyvinyl Alcohol

Associated data

  • ClinicalTrials.gov/NCT03360045