Comparative effectiveness of various non-invasive local treatments in patients with epistaxis: a systematic review and network meta-analysis

The best initial strategy for managing epistaxis is unclear. We performed a systematic review and network meta-analysis to compare the effectiveness of various non-invasive treatments for patients with epistaxis. We searched PubMed, Embase, and the Cochrane Library from inception to September 2022 without language restrictions. Randomized controlled trials assessing immediate hemostasis, 2-day and 7-day rebleeding outcomes, as well as the use of non-invasive interventions for the treatment of epistaxis, were selected. Frequentist network meta-analysis was performed. The systematic review included 20 randomized controlled trials (2,994 participants) involving 12 different interventions. The network meta-analysis demonstrated that topical treatment with tranexamic acid significantly reduced the odds of 2-day rebleeding compared with the control conservative treatment (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.21-0.61) and traditional anterior nasal packing (OR, 0.45; 95% CI, 0.26-0.76). The sensitivity analysis yielded robust results, and the overall evidence was high. Topical tranexamic acid significantly reduced the odds of 7-day rebleeding compared with traditional nasal packing (OR, 0.33; 95% CI, 0.15-0.70), with moderate evidence owing to the heterogeneous results. Despite the significant effects of topical tranexamic acid on achieving immediate hemostasis and Rapid Rhino® nasal packing on preventing 2-day rebleeding compared to the control and traditional nasal packing, the evidence is low to very low due to heterogeneity, inconsistency, and within-study bias. In the treatment of epistaxis, topical tranexamic acid may be superior to conservative treatment or traditional nasal packing, particularly in preventing 2-day rebleeding.