Antazoline 0.5% / Xylometazoline 0.05% eye drops

Background: Epistaxis is a frequent emergency room presentation, with a significant portion of cases requiring active medical intervention. While anterior nasal packing remains a conventional approach, newer pharmacological options like topical tranexamic acid (TXA) have gained attention due to their antifibrinolytic action. Xylometazoline, a topical decongestant with vasoconstrictive properties, is commonly used in emergency settings for anterior epistaxis, yet comparative data between the two agents remain limited. Objective: To compare the efficacy of topical application of intravenous TXA with topical xylometazoline in achieving hemostasis in patients presenting with anterior epistaxis who are on antiplatelet therapy. Methods: This prospective randomized controlled trial was conducted at the Emergency Department of the Pakistan Institute of Medical Sciences, Islamabad, from December 2023 to November 2024. A total of 88 patients, aged 13–60 years, using antiplatelet medications and presenting with anterior epistaxis were enrolled. Patients were randomized into two groups (n=44 each). Group A received 100 mg/mL of intravenous TXA applied topically via nasal spray. Group B received 2–3 puffs of 0.1% xylometazoline spray in each nostril. Hemostasis was assessed at 30 minutes post-administration. SPSS version 25.0 was used for statistical analysis, and chi-square test determined significance at p<0.05. Results: The mean age was 47.3 ± 7.4 years in Group A and 45.3 ± 8.6 years in Group B (p=0.846). Group A comprised 26 males (59%) and 18 females (41%), while Group B had 28 males (63.63%) and 16 females (36.36%) (p=0.568). Hemostasis at 30 minutes was achieved in 10 patients (22.73%) in Group A and 29 patients (65.91%) in Group B, showing a statistically significant difference (p<0.001). Conclusion: Topical xylometazoline demonstrated significantly higher efficacy compared to intravenous TXA preparation in achieving hemostasis for anterior epistaxis in patients on antiplatelet therapy, supporting its role as a first-line intervention in emergency care.

Abstract licence: CC BY-NC-ND

Several drugs may be used to minimize pain during nasal intubation in awake patients. We hypothesized that the analgesic effect of cocaine would be at least as good (non‐inferior) as that of lidocaine with xylometazoline rated as maximum pain felt during awake nasal intubation of healthy volunteers.

Abstract licence: CC BY

Objective: The objective of this study was to compare the efficacy of topical xylometazoline and topical tranexamic acid in achieving bleeding control in patients presenting with anterior epistaxis in the emergency department. Method: After getting approval from the ethical review board, this RCT was conducted at Rawalpindi Teaching Hospital from 2nd February 2024 to 1st February 2025. A total of 80 patients (more than 18 years of age) with spontaneous anterior epistaxis were included in the study using non-probability consecutive sampling. They were randomly assigned to two equal groups (n = 40 each). One group received topical xylometazoline (0.1%), which was put on a cotton pledget and inserted into the affected nostril, while the other group received topical tranexamic acid (500 mg in 5 mL) using the same technique. The pledgets remained in place for 10 minutes. The primary outcome was to note the time to achieve haemostasis, which was categorised into 4 intervals: 5-10 minutes, 11-20 minutes, 21-30 minutes, or more than 30 minutes. If the bleeding had not stopped within 30 minutes, it would mean treatment failure, and the patient would be managed via cautery or nasal packing. The secondary outcome was to note the incidence of rebleeding within 48 hours. Results: In the tranexamic acid group, 45% of patients achieved haemostasis within 5–10 minutes, while only 23% of patients achieved haemostasis in the xylometazoline group in the same period, indicating a statistically significant difference (p = 0.019). An additional 45% of the patients in the tranexamic acid group achieved haemostasis within 11–20 minutes, whereas only 18% in the xylometazoline group stopped bleeding within the same timeframe. In the 21–30-minute category, 15% of the patients treated with tranexamic acid achieved haemostasis compared to 25% in the xylometazoline group. For the secondary outcome of rebleeding within 8 hours,43% of patients in the tranexamic acid group experienced recurrence of bleeding, compared to 50% in the xylometazoline group (p = 0.23). Conclusion: These findings suggest that Topical tranexamic acid is significantly more effective in achieving rapid haemostasis compared to xylometazoline and is associated with a lower failure rate. However, both agents exhibit similar rebleeding rates within 48 hours. Keywords: Epistaxis; Tranexamic acid; Administration, Topical; Hemostasis; Vasoconstrictor agents; Antifibrinolytic agents

Abstract licence: CC BY-SA 4.0