From the Guidelines
To stop a nosebleed, pinch the soft part of your nose shut with your thumb and index finger for 10-15 minutes while leaning slightly forward, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. This applies direct pressure to the bleeding vessels, allowing a clot to form.
- Breathe through your mouth during this time.
- Sitting upright and leaning forward helps prevent blood from flowing down your throat, which could cause nausea or vomiting.
- Applying an ice pack or cold compress to the bridge of your nose can help constrict blood vessels and slow bleeding, although the usefulness of cryotherapy is unknown in the first aid setting 1. After the bleeding stops,
- avoid strenuous activity, hot showers, blowing your nose, or picking at your nose for 24 hours to prevent disturbing the clot. If bleeding persists beyond 20 minutes, is extremely heavy, or occurs frequently,
- seek medical attention, especially if you are taking anticoagulant or antiplatelet medication, or have a blood-clotting disorder 1. Nosebleeds often result from dry nasal membranes, trauma, or blood-thinning medications, and
- using a humidifier or saline nasal spray can help prevent recurrence by keeping nasal passages moist 1.
From the Research
Methods to Stop a Nose Bleed
- Applying external pressure and ice packing to the nose can help stop bleeding in some cases 2
- Topical agents such as oxymetazoline can be effective in stopping 65-75% of nosebleeds 2, 3, 4
- Tranexamic acid can promote hemostasis in 78% of patients, and is more effective than oxymetazoline and nasal packing in some cases 2, 5
- Nasal packing can be applied using non-absorbable or absorbable materials, and newer hemostatic materials can be more effective with fewer complications 2
- Endoscopic ligation of arteries and endoscopic cauterization can be effective methods for stopping nose bleeds, especially in cases where other methods have failed 2
- Embolization can be used in intractable cases, with a success rate of 80% 2
Comparison of Treatments
- Oxymetazoline has been shown to be superior to tranexamic acid and epinephrine-lidocaine in achieving rapid hemostasis and reducing recurrence in epistaxis 3
- Tranexamic acid has been shown to be more effective than topical oxymetazoline in achieving hemostasis in anterior epistaxis 5
- Directive nasal cautery using silver nitrate can be used to control localized bleeding or prominent vessels 6
Outpatient Management
- Compressive therapy is the first step in controlling anterior epistaxis, and can be used in conjunction with oxymetazoline nasal spray or application of cotton soaked in oxymetazoline or epinephrine 6
- Topical therapy and nasal packing can be used if other methods are unsuccessful, but posterior epistaxis is more likely to require hospitalization and nasal packing 6