Exterior Epistaxis: A Case Study

Introduction
Epistaxis is a common complaint in the emergency department (ED) 1. About 60% of population experience epistaxis at least once during their lifetime and 6% needs medical attention 2. The cause of epistaxis is unknown in majority of cases. Known etiologic factors can be divided into local and systemic causes 3. Of all systemic factors, the use of anticoagulants and antiplatelet drugs appear to have a significant correlation with more severe and recurrent epistaxis 4.
Antiplatelet medications specifically aspirin and clopidogrel are widely used in recent years for various forms of cardiovascular disease 3. There is no significant difference in risk of epistaxis in patients taking aspirin or clopidogrel 5. Epistaxis management in

As an inclusion criterion we considered the bleeding of the referred patients with anterior epistaxis severe enough to need medical care (moderate severity). The patients were asked to compress both nostrils with two fingers for 20 minutes as the first aid measures if not encouraged to do that previously. Our exclusion criteria were: epistaxis following trauma, history of anticoagulant drug consumption, inherited bleeding disorders, hemophilia, inherited platelet disorders, INR > 1.5, Shock, visible bleeding vessel, history of renal disease, and lack of consent.
Finally, patients consuming antiplatelet drugs, including aspirin, clopidogrel, or both during the acute phase of epistaxis with a new episode of anterior epistaxis or recurrent anterior epistaxis even with recurrent previous intervention entered in this study. Ethics review committee of our institute approved the study and it was registered at a clinical trial registry. Prior to entry to the trial, written informed consent was obtained from all

In the aforementioned study, the proportion of patients with epistaxis treated with anterior nasal packing and bleeding stop time ≤10 min was approximately 30 percent7. We considered a minimum clinically important difference of 25% to make the topical use of injectable form of tranexamic acid preferable to the alternative, namely anterior nasal packing. Hence, we assumed if the new treatment could achieve 55% success (Δ =25%). A sample size of 57 per group was identified to achieve 80% power with a two-sided significance level of .05. We considered 10% of this figure to add to the calculated sample size to prevent the falling out during follow up, so final sample size was about 62 per