Therapeutic target
Hemostasis
Therapy recommendations
- Apply antifibrinolytic tranexamic acid (→ complex formation with plasminogen, inhibiting its binding to the fibrin surface/inhibiting clot dissolution) to absorbent cotton (500 mg in 5 ml) and apply to anterior source of bleeding
- Possibly cauterize (destroy tissue) with silver nitrate (note: electrocauterization is reported to be more effective than silver nitrate therapy); see “Further Therapy/Special Measures” for more information.
- Osler disease (hereditary hemorrhagic telangiectasia (HHT); autosomal-dominant inherited disorder in which telangiectasia/visible dilatation of superficially located tiny blood vessels occurs; symptomatology: spontaneous and recurrent nosebleeds) can be treated as follows:
- Nasal ointment with estriol 0.1% or
- Propranolol, a nonselective beta-blocker; this could be an alternative substance because it has antiangiogenic potential: 2 x 40 mg/d reduced epistaxis attacks on average from several times per day to less than once daily. The duration of nasal bleeding decreased from a mean of 30 to 10 minutes.
- See also under “Further Therapy.”
Notes
- If a tamponade is to remain in place for more than 24 h, antibiotic/antibiotic therapy (usually doxycycline) should be given.
