Drug-induced epistaxis
Alerts and Notices
Synopsis
A minor anterior nosebleed may resolve on its own with conservative treatment. Monitoring medications and adjusting dosage may minimize bleeding episodes.
Management of bloody nose can include use of a cold compress, pinching the alae against the septum for 15 minutes, and nasal application of antibiotic. For recurrent, heavy bleeding, packing may be used (eg, Merocel tampon) to achieve hemostasis. Other methods include cautery or nasal balloon catheters. Treatment of recurring posterior epistaxis is more complex and may require hospitalization.
Heparin-induced thrombocytopenia (HIT) is a type of drug-induced thrombocytopenia that typically occurs 5-10 days after the initiation of heparin therapy and is diagnosed using the 4 Ts score (thrombocytopenia, timing, thrombosis, and other causes of thrombocytopenia).
Codes
ICD10CM:R04.0 – Epistaxis
SNOMEDCT:
249366005 – Bleeding from nose
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Incidental finding
- Infections – human immunodeficiency virus (HIV), hepatitis C virus, Epstein-Barr virus, Helicobacter pylori, bacterial sepsis with disseminated intravascular coagulation
- Alcohol use disorder
- Nutrient deficiencies – vitamin B12, folate, copper
- Primary immune thrombocytopenia
- Post-transfusion purpura
- Myelodysplastic syndromes
- Aplastic anemia
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:03/27/2019
Last Updated:03/27/2019
Last Updated:03/27/2019