Side Effect: Nosebleed (Epistaxis)

What is a nosebleed?

Epistaxis is a medical term used to describe a nosebleed. It occurs when blood vessels in the lining of the nose rupture, causing bleeding from one or both nostrils. Nosebleeds can range from an occasional mild bleed to a severe and recurrent condition that requires medical intervention.

What does a nosebleed look like?

The appearance of a nosebleed can vary depending on the seriousness of the bleed. The blood usually looks bright red and can range from tiny, slow drops to a constant drip from the nose.

Who gets nosebleeds?

There is an association between cancer, clotting, and bleeding and this can occur in patients of all ages. Risk factors include a low platelet count or blood clotting disorders. You are at increased risk if you’ve received radiation on or near the nose area as well. Certain factors that can exacerbate a blood nose include dry air, nose picking, trauma to the nose, high blood pressure, and certain medications.

Common medications that increase risk:

• Aspirin
• Anticoagulants: warfarin (Coumadin®), apixaban (Eliquis®), rivaroxaban (Xarelto®)
• Anti-cancer medications
• NSAIDs (non-steroid anti-inflammatory drugs): ibuprofen (Motrin®), naproxen (Aleve®), ketorolac (Toradol®)

How long do nosebleeds last?

Nosebleeds vary in severity, which influences the amount of time they last. Some nosebleeds stop as soon as pressure is applied, where others continue with added pressure. It is important for a physician to check labs if a patient has a nosebleed that does not stop.

How to prevent nosebleeds

Preventing nosebleeds involves good nose hygiene and avoiding the risk factors listed above. Patients can use a humidifier to prevent dry air in the room. Avoid blowing the nose hard as this can restart a nosebleed that has recently subsided. Saline spray can keep moisture on the nose as well.

How to treat nosebleeds

Treatment of epistaxis in cancer patients can be challenging and may require multiple people involved. It is important to identify and address any underlying causes of the nosebleed, such as medications, a tumor, or radiation to the nearby area.

Steps to stop a nosebleed

• Sit up and lean forward
• Apply pressure by pinching the soft part of the nose with your hands or a tissue
• Apply ice to the end of the nose
• Do NOT blow your nose

Treatment Options

• Nasal packing: putting gauze in the nose with gauze
• Medications:
  •  In the hospital
    • Aminocaproic acid
    • Tranexamic acid
  • Available at the pharmacy
    • Decongestant sprays with oxymetazoline: Afrin®, Dristan®, Neo-Synephrine®, Vicks Sinex®
    • Bleedstop®
    • Silver nitrate
• Cauterization/embolization: burning the wound with a heated instrument
• Surgery