Persistent Nasal Bleeding Due to Nasal CPAP Application in 2 Premature Newborns Successfully Treated With Topical “Ankaferd Blood Stopper”

Respiratory distress syndrome (RDS) is one of the most common causes of hospitalization of premature babies in newborn intensive care units. Nasal continuous positive airway pressure (CPAP) has been used widely for a long time in the treatment of RDS. Nasal bleeding due to nasal mucosal injury is not rare in the course of nasal CPAP application. Nasal bleeding can usually be controlled uneventfully with simple applications. However, to bring these bleedings under control can sometimes be difficult and time consuming. Furthermore, continuous bleeding can occlude the respiratory route by forming a plug. ¹

Ankaferd Blood Stopper (ABS) is a herbal product that can stop cutaneous, dental, and postoperational external bleeding in a few minutes.^2,3 Herein, we wanted to share our experience in using topical ABS to control epistaxis that had appeared in 2 premature babies related to CPAP application, and which could not be controlled using conventional methods.

Nasal CPAP was applied on 2 premature babies born at 30 and 32 weeks of gestation and hospitalized for RDS treatment. However, unilateral nasal bleeding began on the first and the third day of treatment, respectively. Nasal bleeding was attempted to be controlled using conventional methods (pressure on the nose, irrigation with hot water, topical vasoconstrictor agent application, etc), but bleeding could not be stopped. Thrombocyte counts and routine hemostasis tests of both babies were normal. Intramuscular vitamin K (0.5 mg) was administered at birth. Ankaferd blood stopper (Ankaferd Health Products Ltd, İstanbul, Turkey) was applied onto the bleeding nostrils of both babies as a topical spray form. Bleeding stopped in a few minutes following ABS application and did not recur. No systemic or local adverse effects were observed.

Ankaferd blood stopper is a hemostatic agent consisting of 5 distinct herbal extracts named Urtica dioica, Vitis vinifera, Glycrrhiza glabra, Alpinia officinarum, and Thymus vulgaris. ² This product, which is used in traditional Turkish medicine, has been licensed by the Ministry of Health. There are many clinical and experimental studies proving its effect on controlling digestive tract, oral, nasal, and cutaneous bleedings, which show whether there they accompany any coagulation disorders.^3–7 In published studies, it has been shown that this product has no serious adverse effects.^8,9 Ankaferd blood stopper achieves hemostasis independently from coagulation factors and the classical coagulation cascade. It constitutes a structural network via interference with blood proteins, mainly with fibrinogen, and thus, it provides vital aggregation of erythrocytes.^2,4,5 It can be used both for individuals with normal hemostasis and primary or secondary hemostasis disorders as it does not interfere with the cascade working upon coagulation factors.^2,4,5

Based on our experience in these 2 cases, we can conclude that topical ABS application is a practical, effective, and safe hemostatic treatment modality. We believe that topical ABS application will create a novel treatment modality in superficial cutaneous and mucosal bleedings in newborns including premature babies.