Nose bleeds

[BSA20]

I had a heart attack in September and since then have an irritable right nostril which constantly runs and now bleeds slightly. I take 1.25mg bisoprolol, 12mg eplerenone, 2.5mg ramipril and 2 x 90mg brilique. Has any member experienced this side effect before and, if so, how did you resolve it. I don't want to drip blood onto my Christmas Dinner. Thank you for any advice you can give me. It does say on the bisoprolol leaflet it can cause irritation in the nose.

[Hidden]

Hello

I used to get such bad nose bleeds I had to have my nose cauterised 3 times over a year it was due to the blood thinners I was on and it has not stopped since I was able to come of them

Nothing stopped them till I was of the blood thinners even though I tried

It might be a good idea to speak with your Doctor and see if they think any of the meds could be causing it if they thought Bisoprolol was the cause they could possibly change it even though I still take Bisoprolol and that was not the cause for me but the blood thinners were

Good luck I hope you can get it sorted out and let us know how you get on x

[MountainGoat52]

I would speak to your GP about this issue. It looks like you might have thin veins at the top of your nasal passages and the fact that you are on Brilique (Ticagrelor) won't help as your blood will be thinner and less likely to clot. Some investigation required. ☺

[Gibson01]

It’s most likely the Ticagrelor that is the cause. I had a similar experience 11 months post HA,I which my nose bleed would not stop. I had to go to hospital and have a plug in my nose overnight then cauterises the next day. 4 years on, after a further angio I am on prasugrel ( in lieu of Ticagrelor) and started having nose bleeds again. Spoke to GP and reduced the dose so that it is just about under control.Still wake up with blood in my mouth and blood on tissue when blowing nose. Would definitely speak to GP about reducing the Ticagrelor dose.

[Mentdent]

I had this. I think bisoprolol causes runny nose sometimes and brilique is responsible for nose bleeding. I found it a nuisance sometimes but didn’t worry about it.

[Abbacadabra]

My o/h is on ramipril & other tablets for stroke/heart - you will be on blood thinners. He recently had a cold and suffered quite a few nose bleeds. He also has them on odd occasion. I mentioned it to the doctor and he said that as long as they don't last for more than 15mins it's "normal". I always keep a load of tissues handy.

[MummaSoap]

Hi BSA20

I’m sorry to hear you’re experiencing frequent nosebleeds. It sounds like you’ve had lots of really good suggestions for accessing support and possible solutions but I just wanted to add that when I recently did a first aid course our trainer said that he would recommend that anyone experiencing regular nosebleeds (regardless of their medical history) should get checked out by their gp as their could be a more serious underlying cause.

That’s not to try and put the fear of god in you but just to highlight the importance of investigating nosebleeds.

It more than likely is related to one of your medications, I hope you get sorted quickly. Please let us know how you get on.

Best wishes,

Soap

[Stoer]

I was suffering from mild daily nosebleeds and my GP gave me a prescription only ointment (Naseptim) for it. Unfortunately, for me, it didn't work and I ended up having my nose cauterised - and that worked. As others have said, speak to your GP about your nosebleeds as help is available. I hope you get sorted out soon.

[Wingnutty]

I don't want to worry you but I have pasted below something I wrote for a different forum some years ago about my experience of nosebleeds. A Personal Experience of Nose Bleeds while on Warfarin

Background: 61 year old Male who had a quadruple bypass and aortic valve replacement 5 years earlier on warfarin therapy for life because of the valve . INR range 2.5-3.5, target 3.0.

I had many nose bleeds after starting warfarin, at least weekly. I had always managed to control them with tissue rammed tightly up my nose. Pinching the nose just below the bone in the bridge of the nose is the standard medical advice, but that never stopped the nose bleeds in my case. I was of the opinion that the bleeds were coming from a place higher up the nasal passage than the start of the bone and so pressure below that point had no effect.

On one occasion, a couple of years after the operation, I couldn’t stop the nose bleed and after a couple of hours of trying, I had to go to the emergency department at my local hospital in the UK. I had to wait about an hour to be seen and by that time, the bleed had stopped by itself, so I was sent home, but an INR check was made and it was much higher than my therapeutic range.

At a subsequent outpatient appointment, they decided on no further action apart from the use of a nasal cream in the nose called Naseptin.

A few years later and I had a similar episode, but it seemed even worse this time. Again I went to the Emergency department and because of the rate of blood loss, I was seen quite quickly by a junior doctor. He decided to use a device known as a ‘rapid rhino’ which looks a bit like a tampon but has a tube coming out of it which you can connect to a syringe and then inflate it with air to put pressure on the wound. This device is very uncomfortable and they do cause a lot of collateral damage to the tissue inside of the nostril, but its use was necessary to save my life. The device failed to stop the flow and the blood was now coming down my good nostril because he had blocked off the affected one. The doctor then said he wanted to put another rapid rhino up my good nostril because that would cause pressure to build up inside my nose and stop the bleed wherever it was. I told him that I thought it was very unlikely to be successful, but he still wanted to try it. He tried that and stopped blood coming down both nostrils, but now it was just flowing backwards and down my throat. At that point, he went to get a more senior doctor.

The more senior doctor took the rapid rhino out of the affected nostril and replaced it and managed to tease it a bit higher up than the previous doctor. He had to use a lot of pressure in the rapid rhino, but it did stop the bleeding. When he took the rapid rhino out of the good nostril, that started bleeding because of the damage done by the device, so he had to put that one back in and re-inflate it.

I was admitted to a ward and told to stop taking warfarin for two days. My INR was 4.9 for reasons unknown, but I was not self testing at the time and if your INR is seen to be relatively stable in the UK, the clinic will let you go for anything up to 12 weeks without testing. It had been about 5 weeks since my last test when the bleed happened. The plan was to let my INR drop by not taking warfarin, then to try and cauterise the wound. The next day, they took the pressure out of the rapid rhinos to see if the bleed would continue, but it did, so they had to re-inflate them again.

After two days without warfarin, my INR had dropped to 1.7, and they decided to try and cauterise the wound while the blood was still flowing. This failed and an operation was planned for that evening. The operation was a spheno-palatine artery ligation (SPA ligation). The spheno-palatine

artery supplies blood to the nose and is a branch from the carotid artery in the neck. Ligation, just means tying off the artery. I was told if this failed, they would have to tie off the SPA at the neck end and this would leave a scar on the side of my neck. The operation went ahead and the rapid rhinos were out, but my nose was still bleeding slowly.

I was taken back to the ward and restarted warfarin and started Dalteparin injections for bridging which I learned to do myself so that I could leave the following day and continue until my INR came back up within range. I left the hospital the next day but my nose was still oozing blood slowly. A couple of days later, I had an INR check at the clinic and it was still below range at 1.8.

The next day, the oozing from my nose got gradually worse and worse until it was finally as bad as when it first started a week earlier. I had to go back to the emergency department and insisted on seeing the more senior doctor straight away, after explaining about my previous experience. I saw the same doctor I had seen a week ago. He again used a rapid rhino to stop the bleed and I was taken off warfarin and admitted for a further 4 days. I had no more surgery, but at least one more attempt at cauterisation which failed.

I eventually saw the head of the ENT department and he explained that what had probably happened is that the combination of nose bleed, Dalteparin, aspirin and my INR starting to rise again through the warfarin therapy had restarted the bleed. His suggestion was to stay off the warfarin until the bleed stopped completely which eventually led to being on the Dalteparin injections for almost 6 weeks, but it was worth it. During that time, I was told to stay as calm as possible and do no exercise as this could increase the chance of a bleed again.

8 or 10 weeks after leaving the hospital I started going back to the gym where I used to jog about 2.5km on a treadmill, but I found that I could no longer do that and my aerobic capacity was severely reduced and hasn’t recovered nearly a year later.

I believe there were some serious mistakes made in my treatment by the UK NHS , in particular by the junior doctor using a rapid rhino in the unaffected nostril and sending me home with a bleeding nose and telling me to restart warfarin straight away. Having said that, if it wasn’t for them I would not be in a position to write this document or do anything else and I am sincerely grateful to them for saving my life.

I also believe that if I had been tested more regularly, the situation could have been avoided, so I have now purchased a Coaguchek tester and test myself at least once every 2 weeks.

Now 3 years on from this episode, my aerobic capacity never came back and I suffer from angina when walking. Sorry if this all sounds negative, but I believe in telling it how it is.