15
Figure 6. Patients on Anticoagulants and/or Antiplatelet
Medications
Do one or more of the following apply to this
episode of epistaxis?
• Posterior nosebleed
• Hemodynamic instability due to blood loss
• A decrease in hemoglobin of ≥2 g/dL or
required ≥2 units of RBCs (or ≥15 mL/kg in
pediatric patients)
Bleeding is Severe
• Do not give additional
dose of anticoagulant or
antiplatelet medication while
bleeding is active.
• Initiate appropriate local
measures to control
epistaxis.
• Administer appropriate
reversal agent to control
bleeding and stabilize
patient (see Table 5).
• Assess for and treat other
contributory comorbidities
(e.g., thrombocytopenia,
uremia, liver disease).
Bleeding is Non-Severe
• Do not give additional
dose of anticoagulant or
antiplatelet medication while
bleeding is active.
• Initiate appropriate local
measures to control
epistaxis.
• If patient requires
hospitalization or
transfusion and on a VKA,
consider oral or IV Vitamin K.
• Do not reverse
anticoagulation or transfuse
platelets if bleeding can be
otherwise controlled.
Flow chart to assess and treat epistaxis in patients on anticoagulants and/or antiplatelet
medications. (Adapted from the 2017 American College of Cardiolog y "Expert
Consensus Decision Pathway on Management of Bleeding in Patients on Oral
Anticoagulants.")
Discuss with patient's primary team managing anticoagulation regarding continuing or
discontinuing anticoagulant or antiplatelet medication at time of discharge.
YES
NO
