Epistaxis is a common emergency department (ED) presentation, particularly in patients on antiplatelet and anticoagulation agents. Traditional remedies for bleeding include local vasoconstrictors, silver nitrate, and anterior nasal packing (ANP), each with variable efficacy. In recent years tranexamic acid (TXA) applied topically has gained popularity due to its efficacy, minimal systemic absorption lending to a low side-effect profile, and ease of use for the patient and provider (Zahed, Am J Emerg Med 2013; Ker, Cochrane Database Syst Rev 2013). In this recently published study, Zahed et al narrowed their focus to explore clinical efficacy of topical TXA in patients on antiplatelet agents (aspirin, clopidogrel, or both).
In the U.S., intravenous acetaminophen (IV APAP) has made its way into some emergency departments as part of a multi-modal pain management approach, in part due to a perception of more rapid and effective pain control compared to the oral/rectal routes. In an effort to reduce opioid use, IV APAP seemingly has the potential to increase the number of non-opioid options such as ketorolac, lidocaine, and ketamine. Indeed, in some post-surgery literature, IV APAP has demonstrated a reduction in opioid use. The utility of IV APAP (compared to PO/PR) in the ED is unclear as there is a paucity of head-to-head efficacy studies comparing IV vs PO therapy… until now.