Management Strategies for Epistaxis in Clinical Settings

Epistaxis, or nosebleed, remains one of the most frequent emergencies encountered across primary care, emergency departments and specialist clinics worldwide. Management begins with first-aid measures, including patient positioning, forward head tilt and firm compression over the nasal ala to tamponade bleeding vessels. Topical vasoconstrictors and local anaesthetics often precede mechanical interventions. For anterior bleeds, chemical or electrical cauterisation of visible vessels is frequently deployed, while nasal packing—either absorbable or non-absorbable—serves when cautery is insufficient or inaccessible. Novel haemostatic matrices have emerged as adjuncts to conventional packing, aiming to improve comfort and reduce recurrence. Posterior epistaxis, less common but more challenging, may necessitate endoscopic arterial ligation or endovascular embolisation of branches of the sphenopalatine artery. Systemic factors such as anticoagulant therapy, hypertension and hereditary bleeding diatheses must be addressed to ensure durable haemostasis. Surgical approaches, including arterial ligation of internal maxillary or anterior ethmoidal branches, represent definitive therapy for refractory or life-threatening bleeds. Across all settings, a protocolised, stepwise algorithm that integrates patient risk stratification, resource availability and follow-up planning optimises outcomes and conserves healthcare resources.

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Management Strategies for Epistaxis in Clinical Settings publication trend

The graph below shows the total number of articles in management strategies for epistaxis in clinical settings across all publications each year (not limited to Nature Index journals).

Technical terms

Anterior epistaxis: Bleeding originating from the Kiesselbach plexus on the anterior nasal septum, typically amenable to bedside cauterisation or packing.

Posterior epistaxis: Haemorrhage arising from deeper branches of the sphenopalatine or ethmoidal arteries, often requiring endoscopic ligation or embolisation.

Nasal packing: Insertion of materials (absorbable or non-absorbable) into the nasal cavity to apply direct pressure and promote clot formation.

Cauterisation: Chemical or electrical destruction of bleeding mucosal vessels to achieve haemostasis.

Haemostatic matrix: A biocompatible gel or sponge delivering clotting agents to control bleeding when conventional packing is inadequate.

Endovascular embolisation: Radiological occlusion of arterial branches supplying the nasal mucosa, used for intractable posterior epistaxis.

References

1. Changing Trends in the Management of Epistaxis. International Journal of Otolaryngology (2015).
2. Epistaxis first-aid management: a needs assessment among healthcare providers. Journal of Otolaryngology (2021).
3. An outcomes analysis of anterior epistaxis management in the emergency department. Journal of Otolaryngology (2016).
4. Management of Persistent Epistaxis Using Floseal Hemostatic Matrix vs. traditional nasal packing: a prospective randomized control trial. Journal of Otolaryngology (2018).
5. The role of oral anticoagulants in epistaxis. European Archives of Oto-Rhino-Laryngology (2018).
6. Surgical treatment of severe epistaxis: an eleven-year experience. Brazilian Journal of Otorhinolaryngology (2013).
7. Radiological Diagnosis and Management of Epistaxis. CardioVascular and Interventional Radiology (2013).