From the Guidelines
The most effective initial treatment for epistaxis in the emergency room setting is to have the patient sit down and continuously hold the lower third or soft portion of the nose pinched closed to help the blood clot, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. This approach is supported by the fact that nasal pressure alone is the only intervention required in the vast majority of cases, including 20% of cases managed in EDs. Key considerations in the management of epistaxis include:
- Leaning forward to prevent blood from entering the airway or stomach
- Breathing through the mouth and spitting out any blood
- Avoiding nose-picking, strenuous activity, hot showers, and blood thinners for several days after treatment
- Using saline nasal spray and petroleum jelly at the nostril entrance to prevent recurrence through moisturizing the nasal mucosa While other interventions such as chemical cautery, nasal packing, and tranexamic acid may be considered for more severe cases or persistent bleeding, the initial approach of direct pressure and nasal pinching is the most straightforward and effective method for controlling epistaxis, as supported by the most recent guidelines 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
ER Treatment for Epistaxis
- Epistaxis, or bleeding from the nostrils, nasal cavity, or nasopharynx, can be treated with various methods in the emergency room (ER) setting 2.
- First aid measures such as external pressure and ice packing can stop 65-75% of nosebleeds in the ER 2.
- Topical agents like oxymetazoline can also be effective in stopping epistaxis, with a success rate of 65% as the sole therapy 3 and 71% in achieving hemostasis 4.
Comparison of Treatment Options
- A study comparing the efficacy of oxymetazoline, tranexamic acid, and epinephrine-lidocaine combination found that oxymetazoline was superior in achieving rapid hemostasis and reducing recurrence in epistaxis 4.
- Another study found that topical tranexamic acid was more effective than topical oxymetazoline in achieving hemostasis in anterior epistaxis, with a success rate of 78% compared to 35% for oxymetazoline 5.
- A systematic review of the use of tranexamic acid in epistaxis found that it can be a powerful tool in managing epistaxis, with significant benefit in acute epistaxis management and prophylaxis of recurrent epistaxes 6.
Other Treatment Options
- Electrocautery and chemical cauterization can also be used to treat epistaxis, with electrocautery being more effective and having fewer recurrences than chemical cauterization 2.
- Nasal packing can be applied using non-absorbable or absorbable materials, and newer hemostatic materials can be more effective and have fewer complications 2.
- Endoscopic ligation of arteries and endoscopic cauterization can also be used to treat epistaxis, with high success rates 2.
- Embolization can be used in intractable cases, with a success rate of 80% 2.