Canadian Pharmacists Journal - May/June 2019 - 165

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Figure 1

Nasal blood supply

Source: Tintinalli JE, Stapczynski JS, Ma OJ, et al. Tintinalli's Emergency Medicine: A Comprehensive Study Guide.
7th ed. 2011. New York (NY): McGraw-Hill Education. © McGraw-Hill Education. All rights reserved.

Table 1

Risk factors for epistaxis2,9,10

Male gender
Older age (>65 years)
History of nasal surgery
History of previous epistaxis
Thrombocytopenia (platelets <150 × 109/L)
Congestive heart failure
Peripheral vascular disease
Diabetes
Alcohol abuse
Coagulopathies
Vascular malformations
Antiplatelet and anticoagulant medications

Risk factors

Epistaxis results from damage or rupture of the
vasculature in the nasal cavity. While nearly
40% of cases of epistaxis have been reported to
be idiopathic,8 there are several potential direct
causes, such as trauma (nose picking, facial
injury, foreign body, nasogastric tube placement,
barotrauma), neoplasms and nasal polyps, nasal
dryness, septal perforation, infection and environmental irritants such as cigarette smoke.4,6
Factors that may increase the risk of epistaxis
occurrence are listed in Table 1.2,9,10 As our
population continues to age, with more people
becoming candidates for antithrombotic therapies,11 epistaxis may become more prevalent,
given multiple risk factors will be at play.
C P J / R P C  *  M ay / J u n e  2 0 1 9  *  V O L  1 5 2 ,  N O  3 

Management

Widely accepted, evidence-based guidelines
for the management of epistaxis have not been
developed, although various algorithms that
reflect local practices have been suggested.12
Overall, literature assessing the pharmacologic
management of epistaxis is generally of low
quality, consisting largely of prospective cohorts
and retrospective chart reviews that lack a comparator or control group. Some have studied
agent use in combination, making it problematic to discern the ingredient imparting benefit
(e.g., moisturizer base with medicinal ingredient), while others have used agents in combination with mechanical strategies. Differences in
the patient populations studied further preclude
comparison or combining of data from various
studies; for example, some have included only
patients with anterior or posterior epistaxis,
some have excluded anticoagulated patients
whereas others have included only such patients,
and some have studied specifically inpatient or
outpatient populations. Although most studies assess rebleeding or treatment failure rates,
their definitions of these outcomes are variable.
Given this, data interpretation and comparison
across studies is difficult, only enabling general
recommendations to be made.
While most cases of epistaxis are not life threatening and initial self-management strategies are
appropriate,5 data indicate that only 40% of patients
are able to list a single appropriate general measure
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