From the Guidelines
Topical epinephrine is a viable treatment option for epistaxis, but its use should be approached with caution due to potential systemic complications, as noted in a 2020 clinical practice guideline on nosebleed management 1. When considering topical epinephrine for epistaxis, it's essential to weigh the benefits against the risks, particularly in patients with hypertension, cardiovascular disease, or those taking certain medications.
- The application of topical epinephrine can be effective in achieving hemostasis by causing vasoconstriction of blood vessels, thereby reducing blood flow to the area and promoting clotting.
- However, the use of vasoconstricting agents like epinephrine may be associated with an increased risk of cardiac or other systemic complications, as reported in studies 1.
- Alternative options, such as oxymetazoline or phenylephrine, which are over-the-counter vasoconstrictors, may be considered, especially given that studies report 65% to 75% of patients have resolution of nasal bleeding with oxymetazoline 1.
- In patients without hypertension, cardiovascular disease, or nasal disease, the use of intranasal nasal cautery has shown no differences in mean arterial pressure, suggesting it could be a safer alternative in certain cases 1.
- The decision to use topical epinephrine for epistaxis should be made on a case-by-case basis, taking into account the patient's medical history and the potential risks and benefits, as outlined in the 2020 guideline 1.
From the Research
Topical Epinephrine Acid for Epistaxis
- The use of topical epinephrine acid for epistaxis is mentioned in one study 2, which suggests that oxymetazoline nasal spray or application of cotton soaked in oxymetazoline or epinephrine 1:1,000 may be useful adjuncts to compressive therapy.
- However, the majority of the studies focus on the use of oxymetazoline 3, 4, 5 as a treatment for epistaxis, with one study comparing the efficacy of oxymetazoline, tranexamic acid, and epinephrine-lidocaine combination 5.
- The study comparing the efficacy of different treatments found that oxymetazoline achieved hemostasis in 71% of patients, while epinephrine-lidocaine achieved hemostasis in 49% of patients 5.
- There is limited evidence on the specific use of topical epinephrine acid for epistaxis, and more research is needed to determine its effectiveness compared to other treatments.
Comparison with Other Treatments
- Oxymetazoline has been shown to be effective in treating epistaxis, with success rates ranging from 65% to 75% 3, 4.
- The use of epinephrine-lidocaine combination has been studied, but its efficacy is lower compared to oxymetazoline 5.
- Tranexamic acid has also been studied, but its efficacy is lower compared to oxymetazoline 5.
Clinical Implications
- The use of topical epinephrine acid for epistaxis may be considered as an adjunct to compressive therapy, but its effectiveness is not well established compared to other treatments 2.
- Oxymetazoline is a widely used and effective treatment for epistaxis, and its use is supported by several studies 3, 4, 5.