Summary of findings 2. Tranexamic acid compared to other haemostatic agent for patients with nasal haemorrhage (epistaxis).

Tranexamic acid compared to other haemostatic agent for patients with nasal haemorrhage (epistaxis)
Patient or population: adults with nasal haemorrhage (epistaxis) Setting: outpatients Intervention: tranexamic acid Comparison: other haemostatic agent
Outcomes	Anticipated absolute effects* (95% CI)		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
	Risk with other haemostatic agent	Risk with tranexamic acid
Control of epistaxis: episodes of re‐bleeding over 10 days	We could not assess this outcome due to differences between the intervention and control arms (other than the application of tranexamic acid) after the first 10 minutes of treatment in Zahed 2013 and Zahed 2018 (see Included studies).
Control of epistaxis: time to stop initial bleeding (proportion with bleeding controlled within 10 minutes)	Study population		RR 2.35 (1.90 to 2.92)	460 (3 RCTs)	⊕⊕⊕⊝ MODERATE 1,2,3	Tranexamic acid probably leads to a higher proportion of participants with bleeding controlled within 10 minutes.
	299 per 1000	702 per 1000 (568 to 872)
Severity of re‐bleeding: proportion of patients requiring blood transfusion within 10 days	Outcome not assessed.
Length of hospital stay	We could not assess this outcome due to differences between the intervention and control arms (other than the application of tranexamic acid) after the first 10 minutes of treatment (see Included studies).
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. Five of 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

¹Downgraded by one level due to study limitations (risk of bias ‐ no blinding) (Zahed 2013; Zahed 2018).

²Downgraded by one level for imprecision (wide confidence interval).

³Upgraded by one level ‐ large effect size (RR 2.35).