What is the treatment for epistaxis (nosebleed)?

From the Guidelines

To treat a nosebleed, the most effective initial approach is to sit upright, lean slightly forward, and apply firm, sustained compression to the lower third of the nose for 10 to 15 minutes, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. This method is supported by the highest quality and most recent evidence, which emphasizes the importance of prompt and effective management to reduce morbidity and improve patient outcomes. The application of nasal compression is a simple, yet effective technique that can be performed by the patient or with the assistance of a caregiver.

Key Considerations for Treatment

• The patient should sit upright and lean slightly forward to prevent blood from flowing down the throat.
• Firm, sustained compression should be applied to the lower third of the nose for 10 to 15 minutes without releasing pressure or checking if bleeding has stopped.
• Breathing should be done through the mouth during this time.
• If bleeding persists after 15 minutes of continuous manual pressure, or if the patient becomes lightheaded, medical attention should be sought 1.

Additional Measures

• The use of topical vasoconstrictors, such as oxymetazoline, may be considered if bleeding persists after initial compression, but their effectiveness and potential risks should be weighed carefully 1.
• Humidification, intranasal emollients, and nasal cautery may also be considered as additional treatment options, but their use should be guided by clinical judgment and patient-specific factors 1.

When to Seek Medical Attention

• If bleeding does not stop after 15 minutes of continuous manual pressure.
• If the patient becomes lightheaded or experiences signs of significant blood loss.
• If the patient is taking anticoagulant or antiplatelet medication, or has a blood-clotting disorder.
• If the patient experiences frequent nosebleeds or has a history of trauma to the nose or face 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Treatment Options for Epistaxis

• First aid measures such as external pressure and ice packing can be used to treat epistaxis 2
• Topical agents like oxymetazoline can stop 65-75% of nosebleeds in A&E 2
• Electrocautery is more effective and has fewer recurrences than chemical cauterization 2
• Tranexamic acid promotes hemostasis in 78% of patients, versus 35% and 31% respectively in patients treated with oxymetazoline and nasal packing 2
• Nasal packing can be applied with non-absorbable materials, absorbable materials, and newer hemostatic materials 2
• Endoscopic ligation of arteries, mainly SPA, is more effective than conventional nasal packing 2
• Endoscopic cauterization is more effective than ligation 2
• Embolization can be applied using gelatin sponge, foam, PVA and coils with 80% success rate 2

Comparison of Treatment Options

• Topical application of tranexamic acid reduces the bleeding time and number of rebleeds compared to anterior nasal packing with gelfoam 3
• Tranexamic acid versus placebo: the risk of re-bleeding reduces from 67% to 47% (risk ratio 0.71,95% confidence interval 0.56 to 0.90) 4
• Oral tranexamic acid reduces the risk of re-bleeding from 69% to 49% (risk ratio 0.73,95% confidence interval 0.55 to 0.96) 4
• Topical tranexamic acid reduces the risk of re-bleeding from 66% to 43% (risk ratio 0.66,95% confidence interval 0.41 to 1.05) 4

Initial Management

• Control epistaxis with well-aimed direct pressure for 10-15 minutes 5