Management of Oral Medications in Patients with Epistaxis

Introduction to Epistaxis Management

The American Academy of Otolaryngology-Head and Neck Surgery recommends that patients with epistaxis can safely take oral tablets with water without risk of aspiration or interference with bleeding control 1

The presence of epistaxis does not compromise the patient's ability to swallow oral medications safely, as the nasal cavity and oral cavity are separate 1, 2
Patients with active epistaxis can continue taking oral medications, including anticoagulants and antiplatelets, unless the bleeding is life-threatening 1, 2

The American Academy of Otolaryngology-Head and Neck Surgery explicitly recommends against withholding oral anticoagulants and antiplatelets for routine epistaxis to avoid increased thrombotic risk 1
Acetaminophen tablets should be given for pain control rather than aspirin or NSAIDs, which can worsen bleeding 4, 5
Oral tranexamic acid is specifically used as a treatment for epistaxis and reduces re-bleeding risk from 69% to 49% (RR 0.73, 95% CI 0.55 to 0.96) 3

Continue all medically necessary oral medications unless specifically contraindicated by the severity of bleeding 1, 2
Have the patient sit upright with head tilted slightly forward when taking oral medications 4