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How can intermittent nosebleeds be treated?

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Posted on Tue, 12 Feb 2019
Question: I have suddenly started to have unexpected nosebleeds. Ithapoens when i am leaning forward to pick something up. I am 83 & generally healthy, but nolonger do much exercise. I don ‘t smoke and have a small glass of winne mixed with 1/2 water about 5 times a week with my dinner. I do have 5 stents in my RCA since 2012 & was diagnosed with arthrosclerosis. I am taking clopidogrel, famotidine,metroprolol, losartan. I am also taking levothyroxin, and atorvastatin.
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Answered by Dr. Lekshmi Rita Venugopal (2 hours later)
Brief Answer:

Nosebleeds likely due to the dry nose, clopidogrel, and famotidine

Detailed Answer:

Hello,

Clopidogrel increases bleeding tendencies. The nose bleeds you are experiencing is likely due to a combination of dry nose and effects of Clopidogrel, Famotidine.

Ranitidine (another alternative to Famotidine) rarely causes bleeding by decreasing platelet count.

Dryness of nasal mucosa can cause breakage of small blood vessels and since you are on clopidogrel the bleeding from broken vessels will be more.

You can use a humidifier in your room to avoid a dry nose. Also, use saline nasal drops twice to thrice daily.

Please try switching from Famotidine to Pantoprazole 40 mg in the morning before breakfast. Since you have coronary artery disease, Clopidogrel should be continued.

If bleeding occurs, pinch nose using wash clothes dipped in cold water and lean forward for 10 minutes.

After 10 minutes, release pressure on nose and bleeding must have likely stopped. If not, you can repeat this process for 2 more times.

If the bleeding persists or keeps recurring, please don't wait and follow up with your primary care provider.

Further workup including blood pressure measurements and coagulation profile evaluation will be needed at that point.

If no obvious causes can be identified, recurrent nosebleeds can be controlled by cauterization.

Hope I have answered your query.

Take care

Regards,
Dr Lekshmi Rita Venugopal, General & Family Physician
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Answered by
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Dr. Lekshmi Rita Venugopal

General & Family Physician

Practicing since :2012

Answered : 3665 Questions

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How can intermittent nosebleeds be treated?

Brief Answer: Nosebleeds likely due to the dry nose, clopidogrel, and famotidine Detailed Answer: Hello, Clopidogrel increases bleeding tendencies. The nose bleeds you are experiencing is likely due to a combination of dry nose and effects of Clopidogrel, Famotidine. Ranitidine (another alternative to Famotidine) rarely causes bleeding by decreasing platelet count. Dryness of nasal mucosa can cause breakage of small blood vessels and since you are on clopidogrel the bleeding from broken vessels will be more. You can use a humidifier in your room to avoid a dry nose. Also, use saline nasal drops twice to thrice daily. Please try switching from Famotidine to Pantoprazole 40 mg in the morning before breakfast. Since you have coronary artery disease, Clopidogrel should be continued. If bleeding occurs, pinch nose using wash clothes dipped in cold water and lean forward for 10 minutes. After 10 minutes, release pressure on nose and bleeding must have likely stopped. If not, you can repeat this process for 2 more times. If the bleeding persists or keeps recurring, please don't wait and follow up with your primary care provider. Further workup including blood pressure measurements and coagulation profile evaluation will be needed at that point. If no obvious causes can be identified, recurrent nosebleeds can be controlled by cauterization. Hope I have answered your query. Take care Regards, Dr Lekshmi Rita Venugopal, General & Family Physician