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CPG: Nosebleed (Epistaxis) – Research Needs

CPG: Nosebleed (Epistaxis) – Research Needs

Research Needs section from Nosebleed (Epistaxis) CPG


This guideline was based on the current body of evidence regarding nosebleed (epistaxis). While nosebleeds are common, with an evolving variety of treatment strategies, the number of high-quality studies on nosebleed diagnosis and treatment is surprisingly small. We provide a list to guide ongoing and future study of epistaxis.

  1. Determine predictive factors in history that can help identify patients needing prompt management.
  2. Determine efficacy of various home measures and over-the-counter medications to treat epistaxis. Should these be recommended prior to medical evaluation and treatment?
  3. Determine optimal duration and techniques for digital nasal compression to stop an active nosebleed.
  4. Determine if application of vasoconstrictors is a useful early step to control acute nosebleeds. What is the best timing and method for application of vasoconstrictors in relation to digital nasal compression? What are the effects of vasoconstrictors on short-term.
  5. Determine the role and efficacy of hot water irrigation for treatment of severe or posterior epistaxis.
  6. Determine what factors in nasal packing will lead to short- and long-term control of nosebleeds. Duration of packing? Type of packing material? Duration of observation after pack removal?
  7. Determine the indications for inpatient hospital observation or intensive care monitoring for patients with nosebleeds. After anterior nasal packing? After posterior nasal packing?
  8. Determine the most effective method for nasal cautery. Silver nitrate versus other chemicals versus electrocautery? Does endoscopic visualization improve nosebleed control and/or reduce complications?
  9. Determine whether bilateral simultaneous septal cautery causes septal perforation, and if so, how can we minimize this risk if both sides need treatment?
  10. Determine differences in efficacy, comfort, and morbidity with the use of various dissolvable packing materials.
  11. Determine which patients will benefit from use of systemic antibiotics after nasal packing, and study ideal length of therapy if antibiotic prophylaxis is prescribed.
  12. Determine the most time- and cost-efficient indications for use of nasal endoscopy for patients with epistaxis.
  13. Determine whether hypertension actually causes recurrent or severe nosebleed. What is the ideal management of elevated blood pressure in patients with recurrent epistaxis? With a severe acute nosebleed?
  14. What is the optimal use of nasal saline and other lubricants and moisturizers for prevention of recurrent nosebleed?
  15. Determine the role of TXA, topical or systemic, for acute treatment of nosebleeds. For prevention of nosebleeds? Are there certain clinical situations or patient groups who would benefit from TXA?
  16. Determine the actual risk of nosebleeds for patients taking anticoagulation and/or antiplatelet medications. Are there differences in nosebleed risks among the various medications? What is the increase in nosebleed risk for patients taking low-dose aspirin?
  17. Determine the risk of using various complementary medications and herbal supplements in terms of causing or increasing duration of nosebleeds.
  18. What are the most effective treatments for the prevention of nosebleeds in patients with HHT? Are there topical medications that are beneficial in these patients? Is sclerotherapy helpful and safe?
  19. Assess the impact of epistaxis on QOL in groups commonly affected with nosebleeds (ie, the elderly, patients with renal failure, patients taking medications that impair clotting).
  20. Determine if patient and family education on nosebleeds improves outcomes (fewer recurrent nosebleeds) as well as patient satisfaction.
  21. Determine what clinical information should be collected during the recommended follow-up assessment.
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