The best way to stop a severe nose bleed and what to do about warfarin after a bleed

[Fruitcake100]

Had a nose bleed that would not stop. In AandE had a horrid treatment that put a thing up my nose and into my sinus and the blew them up like a balloon to put pressure on the source of the bleed. This was very painful and I was in hospital for three nights in lots of pain. Is there a gentler way of stopping the bleed and also as I am on warfarin with INR 2.4 do I come off or change to something different, have heard something new about implants instead of warfarin. Any suggestions welcome.

[Finvola]

Awful, my sympathies Fruitcake - I think it is called a rhinopack and it felt like a rhino had been through my head afterwards. I was told it was the protocol in A&E for a severe bleed but once when I was sent to ENT they did a soft pack with anaesthetic - slightly less awful.

I take Apixaban and had several bad bleeds until I identified allergic reactions to common household cleaners as the main culprit. Have you been burning garden waste, sniffing glass cleaner (sorry!) or been exposed to a strong unusual stink? It's important to rule out causes - rather than just accepting 'oh, it's your anticoagulant' which I was repeatedly told. I haven't had a bad bleed in 3 years since cutting out all cleaning sprays - I still take Apixaban. I think it is also important to get physical causes ruled out - things like polyps, although this may already have been done in hospital

Dealing with a bad bleed alone isn't easy and my GP didn't recommend it. One good tip I picked up from ENT was to push an ice cube up against the roof of my mouth - difficult if you are gripping both nostrils, another was not to check the bleed for at least 30 minutes whilst sitting calmly (!!!) gripping. I always kept a bag of loose ice cubes in the freezer - also avoid warm drinks once you get the bleeding stopped.

Horrible, scary things - wishing you a speedy recovery from the bleed and its treatment.

PS, forgot to say that one anticoagulant should have the same effect as another, if they are to do their jobs. The implant you may be referring to is called a Watchman and there are some posts about it if you search in the box at the top right.

[Fruitcake100 in reply to Finvola]

Thankyou for all the helpful advice, I can’t think of anything that started it, just sitting reading the paper. I am home from hospital now andin no pain , such a relief. I have a soft pack in for a couple of days. Now just terrified of having to have that procedure again it was so brutal, my face is still swollen and black and blue. I will certainly try the tricks you suggested.

[BobD Volunteer]

I doubt the nose bleed resulted from the warfarin but no doubt this didn't help. Anticoagulants don't make you bleed in other words so you must have had a weakness there. Perhaps not surprisingly the worst nose bleeds I have had have resulted from aspirin.

Sounds very unpleasant but so glad you are on the mend.

[Fruitcake100 in reply to BobD]

Thankyou for your response , I have no idea what started it , however I would like to research the procedure they used in Aand E and see if there is anything that can help with the pain while they are doing it. I take on board about it not being warfarin which is good news, one less thing to sort out.

[Barb1]

I understand completely as I was in hospital for 4 days with a nose bleed after being bluelighted to a hospital with an ENT dept. The pain from the packs was indescribable. One night I just sat on the bed and cried. The night dr gave me tramadol which had no effect other than making me sick. I was begging them to take the packs out, at least on the side that wasn't bleeding! I would be extremely reluctant to go to hospital with a nose bleed again.

[Fruitcake100 in reply to Barb1]

Yes that sounds exactly like me, no pain killers touched it. I actually said to the team shortly afterwards that if it happened again I would just bleed to death rather than go through that again. Somewhat dramatic and I guess now I might but it shouldn’t have to be like that. There must be a way of helping with the pain while they are doing it and of helping to control the pain afterwards. After the procedure my BPwas 165 over 100, after they removed the balloons I slept, the first time in approx 40 hrs and my BP was 105 over 75.

I reckon that is what pain does to you.

I am not a wimp have had lots of things including a broken nose twice, a frozen shoulder and op, etc etc also given birth to three children , the last one being 10lbs 4oz and I was very slim, but this was the worst pain of the lot.

[Barb1 in reply to Fruitcake100]

I am so with you. I have had also 2 babies of just under 11 pounds. One of which was 23 hours of hell...but 4 days of that sinus pain is indescribable. I would rather take my chances at home if it happens again. Personally I think that they just packed me up for 4 days because that is how long it takes the warfarin (which I am no longer on) to get out of your system.

[MarkS]

I found cauterisation works very well to prevent recurrence. That's done simply by your GP using silver nitrate and just stings a little temporarily.

[Jajarunner]

I have HHT, a bleeding disorder, which meant being on anticoagulants was a nightmare for me. I had to come off them after a month as I'd already lost nearly a litre (of my 4.5 litres) of blood in that time. I cannt be cauterised so I take Transexamic Acid usually. The doctors always panic when I told them this while I was in afib because they assume they are a coagulent, but they are not, they just make the scab more stable hence stopping the bleed and stopping it from recurring. I dont know if this would help you. My haematologist also said you can crush the tablets and put them up your nose which would stop the too (and there are various powders on the market which you can buy which stop wound bleeding) the trouble is it is obviously difficult to get the powder onto the leed site when it is gushing out. It works well on a minor bleed, but if it is pouring lime a tap it is just washed straight out again (I tried tipping the head back briefly and sniffing it up, but it made me gag, but still desperate to es call for desperate measures!). I never heard of Ice cube on roof of mouth, sounds horrible!

Good luck, hope you don't have more of them.

[Fruitcake100 in reply to Jajarunner]

Thank you I am copying all these reply’s and will check out all suggestions then I will talk to the ENT consultant and see what they say. It is easy for them to be dismissive and say I should be grateful that their efficiency saves lives and I do agree but I bet they have never had the treatment themselves. If it happens again I will try all of the above rather than go to Aand E. Trouble is these things never happen at a convenient time, this one started at 9.pm, not much choice of where to get any help.

Hope you keep well sorted too.

[Jajarunner]

Just make sure they realise it isn't an a coagulent. In my experience, ENT doctors can be quite uninformed about transexamic acid!

Glad you could understand my message with all those typos!

[Rubyray]

I take apixaban and a few weeks ago I had a nose bleed that I could not stop. The doctor said try this before I pack it. He said spray neo-synephrine, 2 big squirts in your nose. I immediately did and it stopped the bleeding. He said only use it for nose bleeds. It works every time. I also now use saline spray in my nose once a day as doctor prescribed. No new nose bleeds for weeks now. FYI: Neo-synephrine contains phenylephrine 1%

[HastyHeart in reply to Rubyray]

Hi, I've not posted for a long time as I'm hopefully stable - fingers crossed - on my meds of calcium channel blockers (Slozem), Digoxin, and Warfarin, but I still read the Forum posts every week.

I had a bad nosebleed, after several smaller ones which stopped of their own accord, in the hot Summer of 2016 and ended up in A&E. Fortunately the young doctor said she could see up my left nostril where I was bleeding from and tried cauterisation Thankfully it worked, as she had warned me of the packing treatment, including being admitted, no anaesthetic, very painful, if the cauterisation failed.

I remember my nose inside had been sore at times for a while and blamed my own over-enthusiastic fiddling with it to clear it in the mornings (I snore!) resulting in blood on my hankies, and when blowing hard to clear it out.

I also have to have on repeat prescription a decongesting spray - Beclometasone - to spray up my nose two sprays twice a day , for chronic rhinitis.

I stopped the spray for a few months after the nosebleed, and stopped "fiddling" inside my nose, but the most important thing I tried was, from then to this day, putting a tiny blob of petroleum jelly on my forefinger (very short nail obviously!) into both nostrils onto the septums, then gently massaging my nose outside with both forefingers until I felt the jelly had been spread inside over the septums. I'm very careful blowing my nose now too. Have had to return to the nasal spray but always spray AFTER I've inserted the petroleum jelly, and now down to one spray in each nostril twice a day.

No sign of any polyps, I must add.

Result so far: no more sore nose, no more nosebleeds! I think petroleum jelly well worth trying and like others who experience/d this most unpleasant and frightening business of nosebleeds that won't stop, I'd do anything rather than suffer them, or the possibility of the "packing treatment"!

As you can also imagine, I'm very wary of anything bumping my nose, like stuff falling down on me from top cupboards, getting bumped by dogs and/or children being too enthusiastic. And so on. I instinctively turn my head away from all possibilities of an imminent possible nose bump.

How does one get hold of the neo-synephrine spray to keep in the house or my bag as a "spray"-in-the-pocket for emergencies? I expect I'll just have to risk having another nosebleed first? Oh dear!

[Rubyray in reply to HastyHeart]

The neo-synephrine is over the counter here in the states. I imagine you have a comparative nose spray there. I think afrin is a similar product. Don't know if you have it there. My cardiologist nurse practitioner recommended keeping my nose moist with the saline spray. Seems to work. Hope you have no more nose bleeds. Very uncomfortable.

[Fruitcake100 in reply to HastyHeart]

Yes, Thankyou for that , I also have chronic rhinitis and have a cortisone spray which does help, the constant post nasal drip causes an awful constant cough, however I do wonder if the spray had anything to do with the bleed as it tends to dry it up.

I too use Vaseline up my nose and find it helpful. My Dr today started my Warfarin again in large dose as I have been off it since the bleed, he says I must stay in it because of my AF.

Oh well onwards and upwards as they say.

[Fruitcake100 in reply to Rubyray]

Wow that sounds interesting I will get some if I can. I already use a saline spray which has helped a bit with post nasal drip.

Thank you for your advice.

[Jajarunner]

Yes, I've used boots cold remedy spray and Vic Syntex. They stop small to medium bleeds in my experience. But some AF patients are sensitive to the stuff in them so use sparingly