Nose Bleeds

It is nose bleed season and every year many go to the doctor for this problem. It happens frequently and often for no definite reason. Sometimes nasal trauma, allergies and nose picking may cause this but many times it is hard to tell why it starts.

A typical patient may come in with no definite reason other than needing a blood thinner for atrial fibrillation. Many people are on blood thinners for different reasons, sometimes with cardiac arrhythmias like AFib and cardiac stents, and this makes nose bleeds more likely.

The issue is that an injury to the nasal lining occurs, and that the bleeding does not stop easily. The injury may be trauma from sports or an accident or just nasal dryness. This happens in the winter, when heating dries the home. The clotting is impaired by a blood thinner and one is at risk for significant bleeding in this situation.

The way to stop bleeding would usually be to put pressure on the injury but with nose bleeding the site may not be obvious. Nose bleeding, while definitely inconvenient, is concerning because it is hard to tell how much blood loss there is and where to press to stop the hemorrhage.

How to stop a nosebleed

Step 1

Pinch the nostrils together for 5 minutes with the head forward, so blood does not run down the throat.

If this does not work:

Step 2

Blow any clots from the nose gently, and spray 2 puffs of over-the-counter Afrin nasal spray into the bleeding nostril, and pinch for another 5 minutes.

You should check with your doctor to make sure this is safe.

Do not use Afrin nasal spray if you have a history of heart problems, such as AFib or high blood pressure.

Step 3

If step 2 does not work, spray the Afrin on a cotton ball, place the cotton ball in the bleeding nostril, and pinch to apply pressure over the cotton ball.

Consider going to the emergency room if none of the steps work.

Bleeding may still occur if cauterization or packing is needed, if this happens, follow the above steps.

If packing is placed, take antibiotics and pain medications as directed.

How to prevent nosebleeds

Salt water spray may used to clear crusting, 2 puffs/nostril two or more times a day, blowing the nose gently. After use of nasal saline spray, nasal saline gel may be used to keep the nasal lining moist. Do not use Q-tips. Place 1/2 tsp. in the nostril directly from the tube, then pinch the nostrils to distribute the gel. This is also sometimes available as a spray gel.

If you take a prescribed blood thinner, do not stop this unless directed to by the prescribing doctor. Medications such as ibuprofen (Motrin, Advil) may also make this worse.

Packing may be needed, and this is left in for 3-5 days.

In severe cases, surgery may be needed.