What is the treatment for epistaxis (nosebleed)?

From the Guidelines

The treatment for epistaxis (nosebleed) begins with applying direct pressure to the nose, pinching the soft part of the nose firmly for 10-15 minutes while leaning slightly forward and breathing through the mouth, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1.

Key Steps in Treatment

• Apply direct pressure to the nose to help the blood clot
• Lean forward to prevent blood from entering the airway or stomach
• Breathe through the mouth and spit out any blood
• For persistent bleeding, consider using nasal decongestant sprays like oxymetazoline (Afrin) for up to 3 days
• Petroleum jelly can be applied inside the nostrils to prevent dryness and recurrence

When to Seek Medical Attention

• If bleeding continues despite these measures
• If the person becomes lightheaded from epistaxis
• If there are signs of brain injury, obvious nasal deformity, or signs of facial fracture
• If the person is taking anticoagulant or antiplatelet medication, or has a blood-clotting disorder

Prevention of Future Nosebleeds

• Use a humidifier in dry environments
• Avoid nose picking
• Consider saline nasal sprays to keep nasal passages moist Most nosebleeds occur in the anterior part of the nasal septum (Kiesselbach's plexus) where blood vessels are close to the surface and easily damaged by trauma, dryness, or inflammation 1.

From the Research

Treatment Options for Epistaxis (Nosebleed)

• First aid measures such as external pressure and ice packing can stop 65-75% of nosebleeds 2
• Applying topical agents like oxymetazoline can also be effective in stopping nosebleeds 2
• Tranexamic acid can promote hemostasis in 78% of patients, making it a useful treatment option 2
• Nasal packing with non-absorbable or absorbable materials can be used to control bleeding 2
• Electrocautery and chemical cauterization are also effective treatment options, with electrocautery having fewer recurrences 2
• Endoscopic ligation of arteries, mainly SPA, can be more effective than conventional nasal packing 2
• Endoscopic cauterization can also be used to control bleeding, and is more effective than ligation 2
• Embolization can be used for intractable cases, with a success rate of 80% 2

Simple Measures for Controlling Epistaxis

• Applying digital compression to the nasal alae and anterior septal area for 10-15 minutes can stop nosebleeds in 90%-95% of cases 3
• Tilting the patient's head forward can reduce the risk of blood aspiration 3
• Using well-aimed direct pressure for 10-15 minutes can control epistaxis 4

Importance of Medical History and Examination

• A nosebleed may be a symptom of a more serious underlying disorder, making it essential to take a suitable history and examination 5
• Cautery under local anaesthetic to the vessels of the nasal septum can be used successfully as a treatment for recurrent epistaxis 5

Use of Tranexamic Acid

• Tranexamic acid can reduce the risk of re-bleeding in adult patients with epistaxis, compared to placebo 6
• The quality of evidence relating solely to topical tranexamic acid is low, making it uncertain whether it is effective in stopping bleeding after a single application 6
• Tranexamic acid is probably better than other topical agents in stopping bleeding in the first 10 minutes 6