February 1, 2023

In this episode of Patient Pulse, Dr. Melissa Pynnonen, a Professor of Otolaryngology and Medical Director at University of Michigan, discusses how to manage nuisance nosebleeds. Nuisance bleeding is a common side effect in patients on anticoagulation but usually isn’t life-threatening.

Hello my name is melissa pennington i’m a professor of otolaryngology at the university of michigan in today’s episode of patient pulse i will discuss managing nosebleeds when you’re on anticoagulation and i have no disclosures the medical term for nosebleeds is epistaxis and during this presentation i may use the term epistaxis interchangeably with nosebleeds

This presentation is about how to treat nosebleeds at home certainly almost leaves cannot be treated at home but the ones that i refer to as nuisance nosebleeds can be treated at home i will describe the difference between major and nuisance nosebleeds i’ll show you a video demonstrating how you can treat nuisance nosebleeds at home i’ll tell you when you do

Need to see a specialist about your notes please and i’ll discuss when you need to contact your anticoagulant provider so first of all what is a nuisance nosebleed well certainly a nuisance nosebleed is messy you get blood on your hands blood on your clothes the bathroom towels you might wake up with a nosebleed and you have blood on your pillow in your sheets

With a nuisance nosebleed blood drips from the nose it might drip in separate droplets it might run as a small stream of blood you might see blood clots some of them might be as large as a grape or a quarter and you might spit some of these blood clots from your mouth nuisance nosebleeds might last off and on for hours they might finally stop and then start again

Seemingly for no reason this is what i’m talking about when i talk about nuisance nosebleeds nuisance nosebleeds are really common especially for patients on anticoagulant medication many patients with nuisance nosebleeds go to the emergency department and they often have a pack like a cotton tampon placed in the nose in my surgical practice as an otolaryngologist

And ear nose and throat specialist i frequently see patients with nosebleeds they typically come to me after the pack has been placed in their nose in the emergency department and then my job is to take out the pack and provide treatment so the nosebleed does not return or at least is not a severe or as common what i have learned from 20 years of experience as

An ear nose and throat specialist is that in most circumstances these nosebleeds could have been stopped at home without the need for a pack and without the need for a trip to the emergency department but the problem is that the patient didn’t know how to treat the nosebleed at home so that’s good news for you nuisance nosebleeds can often be stopped at home if

You know exactly what to do and that’s my job my goal is for you to be able to stop these nosebleeds at home so you don’t need to go to the emergency department before we talk about managing nuisance nosebleeds let’s talk about major nosebleeds major nosebleeds cannot be safely treated at home and do need to be treated in the emergency department so let me contrast

For you the difference between a nuisance nosebleed and a major nosebleed when a patient has a nuisance nosebleed the blood runs from the front of the nose in contrast when a patient has a major nosebleed there’s so much blood and large clots that they’re coming out of the mouth and the throat the patient might feel like they’re choking on the blood when a patient

Has a nuisance nosebleed she can use tissues or paper towels to soak up the blood in contrast when a patient has a major nosebleed there’s so much blood that she needs to use bath towels to soak up the blood and finally when a patient has a nuisance nosebleed she may experience that nosebleed as a small drip from her nose it might be off and on and it might last

For hours in contrast with a major nosebleed that patient will have a large amount of bleeding in a short period of time on this slide the symptoms in bold print are symptoms of major nosebleeds major nosebleeds when they occur are terrifying they cannot be treated at home you must call 911 closest emergency department so now let’s talk about nuisance nosebleeds

This picture shows the inside of the nose we’re actually looking inside the left nostril on the left side of the picture you see the nasal septum which is the gristle in the middle of your nose that separates one sides on the other the septum as you can see is covered with this pink tissue called mucosa the mucosa is pink because there are so many small capillary

Blood vessels in the mucosa the mucosa can dry out this often happens in the winter when the air is dry or it commonly happens to patients who use nasal cannula oxygen the oxygen is very dry and this dry oxygen or dry air dries out the mucosa and these blood vessels which are close to the surface crack open and bleed that’s what causes a nosebleed eventually the

Blood will clot and the bleeding stops however if you take anticoagulant medication it can take a long time for that bleeding to stop another thing you see on this picture is the place where the epistaxis or the bleeding is coming from it’s in the center of the picture and there’s a white arrow pointing to it on the right side of the picture you see some lines

They’re just a little bit out of focus those lines are hairs in the nostril and the haters in your nostril they’re at the very front part of the notes the reason i show you this picture is to make the point that most nosebleeds come from that very front part of the nose oftentimes patients will tell me they feel like the blood is coming from higher up or further

Back but in fact that is rarely the case more than 90% of the time with nuisance nose bleeds the blood comes from the front part of the nose and that makes the nose bleeds easier to manage now i’m going to show you a video of myself and how i managed a nuisance nosebleed during this video i will describe using a nose spray medication in the video i refer to what is

Afrin nose spray and i use this to stop my nosebleed you might be thinking to yourself right now that your nosebleeds are much too severe for a simple nose spray to be effective but let me explain i am a surgeon and when i operate inside the nose and i cut the tissue with the scalpel it bleeds a lot and in the operating room when i do surgery afrin is the medicine

That i use to control the bleeding if it works in the operating room it can work for you at home for your nuisance nosebleeds provided you get the nose spray in the right place let’s watch the video and i will show you how nosebleeds can strike anytime particularly during the cold dry months of winter while they can be a messy nuisance they are rarely an emergency

When a nosebleed strikes remain calm lean forward if there is blood in your mouth spit it out do not swallow it apply three sprays of decongestant spray such as afrin into the side that is bleeding pinch the soft part of your nose shut pinch the nose for ten minutes use a clock to keep track of time resist the urge to release the pressure on the nostrils after

A few minutes after 10 minutes let go of your nose if it is still bleeding soak a cotton ball with no spray and place it into the bleeding nostril and pinch for another 10 minutes again use a clock to time it once bleeding is stopped do not blow your nose for at least 2 days check your blood pressure if possible high blood pressure can cause nosebleeds do not

Pinch the bony bridge of your nose remember pinch the soft part of your nosed closed do not pack the nose with tissues or other household items like gauze tissues or tampons this can make the bleeding worse do not tilt your head back or lie flat this may cause you to choke on blood in addition blood in the stomach can make you nauseous and cause vomiting do not

Lift anything heavy like groceries or perform physical activities or household chores such as vacuuming do not pick up young children and babies avoid activities that involve bending over and causing the pressure in your sinuses to increase remember it can take up to two full weeks to heal after a nosebleed preventive care is essential when managing nosebleeds

Most of the products used to treat and prevent nosebleeds can be purchased at your local pharmacy it is also important to keep your nose and nostrils moist during the dry months of winter some ways to keep your nose moist include use an over-the-counter nasal spray every two to three hours while you are awake use a cool mist humidifier to moisten the air in your

Room while you sleep coat the inside of your nostrils with vaseline or air saline nasal gel twice daily especially at night some patients prefer to place a cotton ball coated in vaseline and the affected nostril overnight if you use steroid nasal sprays such as flonase or nasal kourt call your doctor and ask if you need to continue their use steroid sprays can

Dry out your sinuses and increase the risk of nosebleeds remember using nasal saline spray and vaseline are the best methods for preventing nosebleeds it is important to contact your anticoagulation provider about your nosebleeds they may want to perform a blood test or determine if there have been any other changes in your health if you continue to experience

Frequent nosebleeds you may benefit from an evaluation by an ear-nose-throat physician keep in mind that the anticoagulation clinic can help arrange that appointment if one becomes necessary it is important that you contact your anticoagulation provider if you have more than three to four nosebleeds per week or more than six per month when following the tips

Provided in this video nosebleeds are a nuisance but rarely an emergency however there are some situations when nosebleeds require immediate medical attention bleeding that does not stop in 30 minutes bleeding that is very heavy and that includes blood running down your throat and out of your nostrils bleeding with other symptoms including but not limited to high

Blood pressure dizziness chest pain or rapid heart rate these symptoms may require special treatment remember nosebleeds are common in patients who take blood thinners they can be frightening at first but are rarely dangerous and can be easily managed at home if you know what steps to take to prevent them and what to do when they occur with the advice in my video

You can try to manage your nuisance nosebleeds at home you will need to buy cotton balls and nose spray and i’d recommend you buy these supplies before your first nosebleed that way you’ll be prepared and the experience will be less frightening on this slide are listed two types of decongestant nose sprays oxymetazoline and phenol efrain either one of these types

Of medicines will work to treat a nosebleed and there are several brand names listed there for you as well i can explain a bit about how these medicines work a blood vessel is like a pipe it has a diameter and these medicines cause the diameter of the blood vessel to decrease that means the blood vessel squeezes down it gets smaller that slows down the bleeding

And allows a blood clot a chance to form this in conjunction with holding pressure on the soft part of the nose can be very effective to treat a nosebleed in fact if i am in the emergency department and i see a patient who has a nosebleed this is exactly how i treat it and finally when should you see an ear nose and throat specialist about your nose bleeds so

If your nosebleeds occur frequently it can be a messy frustrating nuisance and an ear nose and throat specialist may be able to help as a general guideline i suggest three or more nuisance nosebleeds a month might be enough that you would benefit from seeing a specialist and then certainly a severe nosebleed so any nosebleed that’s bad enough that you need to go

To the emergency department to have it treated it’s worth seeing an ear nose and throat specialist to follow up on that so in conclusion nuisance nosebleeds can often be treated at home be sure to keep supplies on hand including oxymetazoline orphan elephant nose spray and cotton balls if you have frequent nosebleeds see in otolaryngology or ear nose and throat

Specialists do not stop your anticoagulant medication and if you have frequent nosebleeds or a major nosebleed you certainly should call your anti kawaii when provider thank you for listening

Transcribed from video
Patient Pulse: Managing Nosebleeds When You're on Anticoagulation By NAThrombosisForum