Summary of findings for the main comparison. Tranexamic acid compared to placebo plus usual care or usual care alone for patients with nasal haemorrhage (epistaxis).
| Tranexamic acid compared to placebo plus usual care or usual care alone for patients with nasal haemorrhage (epistaxis) | ||||||
| Patient or population: adults with nasal haemorrhage (epistaxis) Setting: inpatients and outpatients Intervention: tranexamic acid Comparison: placebo plus usual care or usual care alone | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | What happens? | |
| Risk with placebo plus usual care or usual care alone | Risk with tranexamic acid | |||||
| Control of epistaxis: episodes of re‐bleeding over 10 days All treatments (topical and oral) |
Study population | RR 0.71 (0.56 to 0.90) | 225 (3 RCTs) | ⊕⊕⊕⊝ MODERATE 1 | Tranexamic acid probably leads to fewer re‐bleeding events compared to placebo at 10 days | |
| 672 per 1000 | 477 per 1000 (376 to 605) | |||||
| Control of epistaxis: episodes of re‐bleeding over 10 days Oral treatment only | Study population | RR 0.73 (0.55 to 0.96) | 157 (2 RCTs) | ⊕⊕⊕⊝ MODERATE 1 | Oral tranexamic acid probably leads to fewer re‐bleeding events compared to placebo at 10 days | |
| 679 per 1000 | 496 per 1000 (373 to 652) | |||||
| Control of epistaxis: episodes of re‐bleeding over 10 days Topical application (10% gel) only | Study population | RR 0.66 (0.41 to 1.05) | 68 (1 RCT) | ⊕⊕⊝⊝ LOW 1,2 | A single study found no evidence of a difference in the chance of re‐bleeding in the 10 days after a single topical application of tranexamic acid | |
| 658 per 1000 | 434 per 1000 (270 to 691) | |||||
| Control of epistaxis: time to stop initial bleeding (proportion of patients whose bleeding is controlled in ≤ 30 minutes) | Study population | RR 0.79 (0.56 to 1.11) | 68 (1 RCT) |
⊕⊕⊝⊝ LOW 1,2 | A single study found no evidence of a difference in the proportion of patients whose epistaxis was controlled in the first 30 minutes | |
| 600 per 1000 | 474 per 1000 (336 to 666) | |||||
| Severity of re‐bleeding: proportion of patients requiring blood transfusion within 10 days | Study population | RR 0.81 (0.27 to 2.48) | 89 (1 RCT) | ⊕⊕⊝⊝ LOW 1,2 | A single study found no evidence of a difference in the proportion of patients needing a blood transfusion | |
| 136 per 1000 | 110 per 1000 (37 to 338) | |||||
| Length of hospital stay | One study reported a significantly shorter stay in the oral tranexamic acid group (MD ‐1.60 days, 95% CI ‐2.49 to ‐0.71; 68 participants). The other study found no evidence of a difference between the groups. | 157 (2 RCTs) | ‐ | We did not pool the data due to heterogeneity | ||
| Adverse effects: serious or other | See comment | See comment | ‐ | ‐ | ‐ | No study specifically sought to identify and report our primary outcome, the significant adverse effects of seizure and thromboembolism. All the studies recorded "adverse effects" in a general way and there were no significant differences between groups in the occurrence of the minor adverse effects noted (e.g. mild nausea and diarrhoea, 'bad taste' of gel). |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1Imprecision: downgraded by one level ‐ small number of studies (or single study) and small number of participants (per study). 2Study limitations (risk of bias): downgraded by one level due to study risk of bias (differences in baseline severity of bleeding that could affect the result in Tibbelin 1995; selective reporting in White 1988).