NoPAC Trial

NoPAC Trial⁵

• Published in the Annals of Emergency Medicine in February 2021, this study aimed to investigate the effectiveness of topical intranasal TXA in adult patients presenting to the ED with persistent epistaxis and determine whether it reduced the need for anterior nasal packing.
• This was a randomized, double-blind, placebo-controlled trial conducted across 26 EDs in the United Kingdom.
• Participants with spontaneous epistaxis persisting after simple first aid and the application of a topical vasoconstrictor were randomly allocated to receive topical tranexamic acid or placebo.
• The study sample consisted of 496 participants with spontaneous epistaxis, persisting after simple first aid and application of a topical vasoconstrictor.
• In total, 211 participants (42.5%) received anterior nasal packing during the index ED attendance, including 111 of 254 (43.7%) in the tranexamic acid group versus 100 of 242 (41.3%) in the placebo group.
• The difference was not statistically significant (odds ratio 1.107; 95% confidence interval 0.769 to 1.594; P=.59). Furthermore, there were no statistically significant differences between tranexamic acid and placebo for any of the secondary outcome measures.
• The power calculation was based upon an estimated 95% of patients requiring anterior nasal packing; this number was far less, suggesting the study may have been underpowered to find a difference.
• In patients presenting to an ED with atraumatic epistaxis that is uncontrolled with simple first aid measures, topical tranexamic acid applied in the bleeding nostril on a cotton wool dental roll is no more effective than placebo at controlling bleeding and reducing the need for anterior nasal packing.