Severe nosebleed

[398emb]

Last week I had to be taken by ambulance to A&E with a severe nosebleed. Despite the doctors there, and internal nose packing, I was still bleeding two days later, and I was told that I had lost over 3 units of blood. Eventually the flow was controlled sufficiently to perform a cauterisation. I was in hospital for 5 days, and felt OK when they discharged me, but now I am home I feel exhausted, and often seem to "run out of breath" when speaking. Could this be due to the anaemia that has resulted?

While I was in hospital they gave me a Warfarin reversal, and stopped all my medication for 4 days, including Flecainide and Dronedarone, with the unsurprising result that I went into AF for 24 hrs, throwing the Nurses and doctors into a panic! Eventually they gave me my meds, and asked ME to control it, as I would at home!! I did, and only then did they let me take my normal daily meds , excluding Warfarin. I am now home on 6mg daily, where before I was on 4mg.

Has anyone else had such a problem, and how long did it take to feel better?

[Finvola]

Greatest sympathies - what are terrible experience and how good it must feel to be at home again. I've had nosebleeds and packing but never on that scale and for so long. A couple of questions, is your GP aware of the problem and did the hospital doctor think the cause has been identified and cauterisation will remove it? I always felt whacked after a 2 hour bleed but for me it was the trauma of the bleed itself and the hospital journey.

I would certainly get my GP and if necessary cardiologist involved to ensure that all is well and the underlying problem is gone.

[398emb in reply to Finvola]

I think that the Hospital is as bemused as I am!

When admitted, after 1 hr of gushing, my BP was 220/140ish, but when asked they said that they were not sure if my BP was high because of the bleed, or the bleed was because the BP was high. Once on the ward it soon started to fall again, and at one point it was 98/48, but it steadied before my discharge to around 135/85 I think that they cauterised the last vessel that was bleeding so that they did not need to re-pack my nose - a dreadful experience, but better than bleeding! They also wanted the bed, I think, and I did feel anxious to get home.

This was my first ever nosebleed, with the exception of an accidental nasal cat scratch a few years ago, and a quick cauterisation soon stopped that. It was impossible to spit the blood out, as they advised me to, as it was a torrent down my throat, and it has taken a full week for the resulting stomach issues to resolve! It feels a bit pathetic to tell people I had to be admitted with a mere nosebleed, but they tell me that if I hadn't called 111 for advice when I did I might have bled out. Scary....

[Finvola in reply to 398emb]

Scary indeed - I was thoroughly 'told off' by my GP's colleague for describing my embarrassment at going to A & E with 'only a nosebleed'. She was adamant that if necessary I should dial 999 with a bleed which didn't stop in 30 minutes - without the slightest embarrassment. So glad you're OK.

[PeterWh]

I would certainly get your INR checked either at your GPs or the hospital (whichever can get the RESULT quicker. Seems strange that they increased the dose by 50%.

I had a vitamin K reversal of warfarin and my INR was back to 2.3 only 5 days later and for 2 of those days I took 4mg (normal weekend dose for me) and 5 mg the other 3 days (normal weekday dose for me).

However everyone is different.

[398emb in reply to PeterWh]

On Friday my INR was 1.1, but I always seem to react slowly to Warfarin. I am having another check tomorrow.

[Hidden]

How absolutely awful for you. No wonder you feel exhausted. Can't say I've ever suffered from nose bleeds to thst extent but my sympathies all the same.

Sandra

[Barb1]

Yes. I had similar. Was blue lighted from local A and E to an ear nose and throat unit. The packing was terrible and gave me severe sinus pain. I was sure the bleeding had stopped but they insisted on keeping the packing there. In both nostrils even though only one bleeding. They did not give me vit K, just stopped the warfarin fir 4 days. My INR was over 5 which is why after that I bought a Coaguchek. No way do I want to repeat those 5 days of hell. They didn't see anything major to cauterise. I have had bleeds since but not as bad and I always check my INR after.

[PeterWh in reply to Barb1]

And what is your INR afterwards usually?

[Barb1]

It is supposed to be 2.6 but varies usually from 1.8 - 3.6

[398emb]

Well, my INR is still only 1.2, but I'm renowned as a "slow reactor" and it took weeks to get my INR to 2.5 in the first place! The nurse commented on my pale appearance, due to the anaemia caused by bloodloss, but I am already on Iron since last week. Hopefully my INR will soon be back to 2.5ish, on my new dosage of 7mg Warfarin, except Saturday, when it's 8!

My BP is slightly high, at 140/87, but I had a difficult drive over - I hate being behind a 30mph driver when the speed limit is 60! I am sure that it is just ignorance, when we reached a limit of 40, they actually speeded up! The nurse also took blood today to see if I am diabetic - a fingerstick is showing OK, but a sample at the hospital showed a slightly elevated level of something or other!

I don't feel quite as bad as over the weekend, but I am definitely not yet myself, whoever that may be!!

[PeterWh in reply to 398emb]

It will take time. Patience is a virtue!!!!

[398emb in reply to PeterWh]

You are actually the second person to say that to me, on two entirely different topics! Unfortunately, I seem to have two settings; Full ahead and stop dead! At 58 I can't see things changing soon....

[PeterWh in reply to 398emb]

Well I'm only 61.

Unfortunately I have a couple of other comorbidities which complicates things. Since a year ago they have been doing regular monitoring for just over a year and registrar has just recommended to lead consultant that I have an angiogran before they decide the exact way forward. Been frustrating as my 1st ablation was 30th March last year and EP has been waiting for heart valve / cardiologists decisions and recommendations before I have my second ablation.