From the Guidelines
Nosebleeds are primarily caused by the rupture of blood vessels in the nose, often due to dry air, nose picking, allergies, blood-thinning medications, high blood pressure, and chemical irritants, as supported by recent clinical practice guidelines 1. The most common causes of nosebleeds include:
- Dry air, which dries out nasal membranes making them prone to bleeding
- Nose picking or trauma to the nose
- Allergies or colds that cause inflammation
- Blood-thinning medications like aspirin, warfarin, or NSAIDs
- High blood pressure
- Chemical irritants like cigarette smoke To stop a nosebleed, it is recommended to sit upright, lean slightly forward, pinch the soft part of the nose shut for 10-15 minutes, and breathe through the mouth, as suggested by clinical practice guidelines 1. Applying an ice pack to the bridge of the nose to constrict blood vessels can also be helpful. Prevention of nosebleeds includes:
- Using a humidifier in dry environments
- Applying petroleum jelly inside the nostrils with a cotton swab
- Avoiding nose picking
- Using saline nasal sprays to keep membranes moist If nosebleeds are frequent or severe, last longer than 20 minutes despite pressure, or occur after head trauma, it is essential to seek medical attention as they may indicate an underlying condition requiring treatment, such as hereditary hemorrhagic telangiectasia (HHT) 1. In patients with HHT, topical medications like tranexamic acid (TXA) and thalidomide may be effective in reducing the severity and frequency of nosebleeds, as reported in recent studies 1. However, it is crucial to consult with a healthcare provider to determine the best course of treatment for individual cases.
From the Research
Causes of Nosebleeds
- Anticoagulant therapy is a main risk factor for epistaxis, as seen in patients taking warfarin, rivaroxaban, and dabigatran 2, 3
- Antiplatelet agents, such as acetylsalicylic acid and clopidogrel, can also contribute to the development of epistaxis 3
- The use of direct oral anticoagulants (DOACs) has increased the complexity of managing epistaxis due to their mechanism of action and lack of reversal agents 4, 2
Factors Influencing Epistaxis Severity
- Location of bleeding: anterior epistaxis is more common and often easier to manage, while posterior epistaxis is more likely to require hospitalization and nasal packing 5, 3
- Type of anticoagulant therapy: factor Xa inhibitors, such as rivaroxaban and apixaban, may have different effects on epistaxis severity and management compared to warfarin and antiplatelet agents 2, 3
- Patient demographics and medical history: age, sex, and comorbidities may influence the severity and management of epistaxis 2, 3
Management Strategies
- Compressive therapy, oxymetazoline nasal spray, and directive nasal cautery are common methods for controlling anterior epistaxis 5
- Topical therapy and nasal packing may be used for more severe or posterior epistaxis 5
- Management of anticoagulant therapy, including reversal agents and cessation of therapy, is crucial in the treatment of epistaxis 4, 2, 3