Topical Tranexamic Acid Application to Facilitate Biopsy Acquisition in Endoscopic Nasopharyngeal Biopsy: A Prospective Case Series Analysis

Background: Nasopharyngeal carcinoma diagnosis requires endoscopic biopsy, but intraoperative hemorrhage frequently impairs visualization and compromises tissue sampling quality. This prospective case series evaluated topical tranexamic acid (TXA) as a hemostatic adjunct to improve biopsy conditions in suspected nasopharyngeal malignancy. Methods: Adults (≥18 years) with clinically/radiologically suspected nasopharyngeal tumors underwent pre-biopsy laboratory screening and exclusion of thromboembolic risk factors. After topical lidocaine anesthesia, a TXA-soaked cotton pledget was applied to the lesion for 10 min prior to forceps biopsy using 0° 4 mm endoscopy. Bleeding severity was graded pragmatically (minimal: ≤3 gauze pledgets; moderate: >3 or cauterization). Comparative analyses excluded rare diagnoses (n = 1). Results: Of 40 enrolled patients, 34 underwent biopsy (mean age 58.4 ± 12.3 years). All 34 biopsies (100%) yielded conclusive histopathological diagnoses. Adequate hemostasis was achieved in 97.1% (33/34), with minimal bleeding in 76.5% and moderate/massive in 23.5%. Non-keratinizing squamous cell carcinoma (44.1%) showed higher moderate bleeding rates than other diagnoses (Fisher’s exact p = 0.00035). Mean hospitalization was 1.79 ± 1.92 days, uniform across categories. No TXA-related adverse events occurred. Conclusions: Topical TXA provided safe, effective hemostasis during nasopharyngeal biopsy across diverse pathologies, achieving 100% diagnostic adequacy and short hospital stays. Controlled trials comparing TXA versus standard hemostatic techniques are warranted.