What is the treatment for episodic epistaxis (nose bleed)?

From the Guidelines

For episodic epistaxis, the most effective initial treatment is to sit with the head slightly forward and pinch the nostrils for 10 to 15 minutes, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid [ 1 ]. This approach is supported by the highest quality and most recent evidence, which emphasizes the importance of direct pressure in managing epistaxis.

Key Considerations

• If the bleeding does not stop after 15 minutes of continuous manual pressure, or if the individual becomes lightheaded, it is crucial to seek medical attention [ 1 ].
• For individuals taking anticoagulant or antiplatelet medication, or those with a blood-clotting disorder, seeking care from a healthcare professional is reasonable unless the bleeding has stopped [ 1 ].
• The use of cryotherapy (ice) in the first aid setting for epistaxis is of unknown usefulness [ 1 ].

Additional Measures

• Keeping the inside of the nose moist with saline nasal sprays can help prevent dryness and cracking of the nasal membranes, which can contribute to nosebleeds [ 1 ].
• Avoiding picking the nose, blowing forcefully, or using blood-thinning medications can also help prevent episodes of epistaxis [ 1 ].
• Humidifying the home environment, especially in dry seasons, may help reduce the frequency of nosebleeds [ 1 ].

Medical Intervention

• If bleeding persists or is severe, medical attention may be necessary, and treatments such as antibiotic ointments or cauterization may be recommended [ 1 ].
• In cases of persistent or recurrent bleeding not controlled by packing or nasal cauterization, surgical arterial ligation or endovascular embolization may be considered [ 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 effective in stopping nosebleeds, with a success rate of 65-75% in emergency departments 2
• Topical agents like oxymetazoline can also be used to stop bleeding, with a success rate of 65-75% 2
• Electrocautery is a more effective treatment option, with fewer recurrences (14.5% vs. 35.1%) compared to chemical cauterization 2
• Tranexamic acid can be used to promote hemostasis, with a success rate of 78% in patients, compared to 35% and 31% in patients treated with oxymetazoline and nasal packing, respectively 2
• Nasal packing can be applied using non-absorbable materials, such as petroleum jelly, BIPP gauze, and PVA nasal tampons, as well as absorbable materials like nasal tampon (Nasopore) 2
• Newer hemostatic materials, including hemostatic gauzes (Surgicel), thrombin matrix (Floseal), gelatin sponge (Spongostan), and fibrin glue, are more effective and have fewer complications compared to traditional methods 2
• Endoscopic ligation of arteries, mainly the sphenopalatine artery, is a more effective treatment option, with a success rate of 97% compared to conventional nasal packing (62%) 2
• Endoscopic cauterization is also a more effective treatment option compared to ligation 2
• Embolization can be used to treat intractable cases, with a success rate of 80% and comparable efficacy and complications to surgical methods 2

Use of Tranexamic Acid in Epistaxis Treatment

• Tranexamic acid has been shown to reduce the risk of re-bleeding in patients with epistaxis, with a risk ratio of 0.71 (95% CI 0.56 to 0.90) compared to placebo 3
• Topical tranexamic acid has been shown to be effective in stopping bleeding in the first 10 minutes, with a risk ratio of 2.35 (95% CI 1.90 to 2.92) compared to other haemostatic agents 3
• Injectable form of tranexamic acid has been shown to be effective in treating anterior epistaxis, with a success rate of 71% in stopping bleeding within 10 minutes, compared to 31.2% in the anterior nasal packing group 4

Other Treatment Options

• Nasal saline gel has been shown to be an effective treatment option for recurrent anterior epistaxis in anticoagulated patients, with a success rate of 93.2% in stopping bleeding at 3 months 5
• First aid measures, such as tilting the patient's head forward and applying digital compression to the nasal alae and anterior septal area, can be effective in stopping nosebleeds in 90%-95% of cases 6