Topical tranexamic acid for bleeding varicose veins

February 19, 2020

June 1, 2020

James van Oppen, Emergency Medicine Registrar (University Hospitals of Leicester NHS Trust)

In people with bleeding [varicose veins], does topical [tranexamic acid] improve [haemostasis] achievement?

A 60-year old gentleman travels by ambulance to ED Majors. A varicose vein on the dorsum of his foot was caught on his sock while dressing. A puddle of blood quickly appeared. Despite direct pressure by the person and the ambulance service, the varicosity is still bleeding.

You elevate the foot above the person's heart. You apply a compression dressing up to the level of their knee. You consider applying tranexamic acid as a topical haemostatic agent to reduce blood loss.

Medline 1946 to 15 May 2020 using the Ovid interface and the Cochrane Central database to 15 May 2020.

Medline: [Varicose Veins/ OR varicose.mp OR vein.mp OR Veins/] AND [tranexamic acid.mp OR Tranexamic Acid/ OR Antifibrinolytic Agents/ OR txa.mp] AND [haemostasis.mp OR Blood Coagulation/ OR Hemostasis/ OR Hemorrhage/ OR bleeding.mp]

Cochrane: 'varicose' AND 'tranexamic'

After removal of duplicates, 104 citations were found through Medline and 1 through Cochrane Central. There were no papers addressing the clinical question.

Ineligible citations included two systematic reviews comparing topical administration of tranexamic acid to placebo in surgery. Both reviews reported reduced blood loss when topical tranexamic acid was applied.

We found no published literature appraising tranexamic acid administration for bleeding varicose veins.

Administration of tranexamic acid for haemorrhage has few side-effects. However, there is no evidence for its use in bleeding varicose veins.

Level 3: Small numbers of small studies or great heterogeneity or very different population