9
Table 3. Summary of Evidence-Based Statements
Statement Action Grade
7b: Examination of
nasal cavity and
nasopharynx
using nasal
endoscopy
e clinician may perform, or may refer
to a clinician who can perform, nasal
endoscopy to examine the nasal cavity and
nasopharynx in patients with epistaxis
that is difficult to control or when there
is concern for unrecognized patholog y
contributing to epistaxis.
Option
8: Appropriate
interventions for
identified bleeding
site
e clinician should treat patients with
an identified site of bleeding with an
appropriate intervention, which may
include one or more of the following :
topical vasoconstrictors, nasal cautery, and
moisturizing or lubricating agents.
Recommendation
9: Nasal cautery When nasal cautery is chosen for
treatment, the clinician should anesthetize
the bleeding site and restrict application
of cautery only to the active or suspected
site(s) of bleeding.
Recommendation
10: Ligation and/
or embolization
for persistent
nosebleeds
e clinician should evaluate, or refer to a
clinician who can evaluate, candidacy for
surgical arterial ligation or endovascular
embolization for patients with persistent
or recurrent bleeding not controlled by
packing or nasal cauterization.
Recommendation
11: Management of
patients using
anticoagulation
and antiplatelet
medications
In the absence of life-threatening bleeding,
the clinician should initiate first-line
treatments prior to transfusion, reversal
of anticoagulation, or withdrawal of
anticoagulation/antiplatelet medications
for patients using these medications.
Recommendation
12: Hereditary
hemorrhagic
telangiectasia
(HHT)
identification
e clinician should assess, or refer to a
specialist who can assess, the presence of
nasal telangiectasias and/or oral mucosal
telangiectasias in patients who have a
history of recurrent bilateral nosebleeds or
a family history of recurrent nosebleeds,
to diagnose hereditary hemorrhagic
telangiectasia syndrome.
Recommendation
13: Patient
education and
prevention
e clinician should educate patients with
nosebleeds and their caregivers about
preventive measures for nosebleeds, home
treatment for nosebleeds, and indications
to seek additional medical care.
Recommendation
14: Nosebleed
outcomes
e clinician or designee should
document the outcome of intervention
within 30 days or document transition
of care, in patients who had a nosebleed
treated with nonresorbable packing,
surgery, or arterial ligation/embolization.
Recommendation
