Is severe epistaxis associated with acetylsalicylic acid intake?

Abstract

Objectives/Hypothesis: Epistaxis represents a very common emergency in any ear, nose, and throat (ENT) department around the world. Despite other risk factors, acetylsalicylic acid (ASA) contributes to nosebleeds by its intrinsic ability to impair thrombocyte aggregation. The aim of this study was to investigate the influence of ASA on the severity of epistaxis and to compare it with other potential risk factors.Study Design: A prospective cohort study was performed at the ENT department of University Hospital Zurich.Methods: A total of 591 events were evaluated concerning surgical interventions and the length of in-hospital stay. Further analyses regarding recurrences and number of treatments and a specially designed severity score, as well as other outcome parameters, were performed.Results: Ninety-nine patients needed to stay inhospital for at least 1 day. Nearly 30% of all patients had ASA intake, and only 18% were on vitamin K antagonist therapy. Patients on ASA showed significantly more surgical interventions, a higher recurrence rate, and a larger number of required treatments as well as an increased severity score. Duration of in-hospital stay and the complication rate, however, were not associated with drug intake.Conclusions: We not only identified ASA to be one of the major risk factors in epistaxis, but also quantified its impact on the severity of nose bleeding. We emphasize the importance of a well-indicated antiaggregational therapy, and strongly discourage using ASA as a life-style drug for the elderly. ASA therapy needs to be discontinued whenever possible and reasonable.

Current Approaches to Epistaxis Treatment in Primary and Secondary Care

“…About 24% to 33% of all patients hospitalized for epistaxis take anticoagulants and/or antiplatelet drugs (20,21). Ingestion of acetylsalicylic acid increases the severity and number of recurrences of epistaxis and the need for surgical intervention (22,23). A retrospective cohort study in Zurich,…”

Blood markers of alcohol use in epistaxis patients

“…None of the patients that presented repeatedly had pathologic MCV levels at any visit. The source of bleeding, treatments and complications were also noted and have been published previously [1].…”

“…Although the diagnosis rarely poses a difficulty, its treatment can be quite troublesome and patients often inquire about preventive measures that could be taken. The identification of risk factors in epistaxis therefore is essential and different causatives could be identified including antiaggregational drugs, anticoagulants and seasonal weather changes [1,2]. The misuse of alcohol has been noticed in up to 25% of individuals admitted to an emergency ward [3].…”

“…Epistaxis is the most common emergency in rhinology and accounts for almost 600 consultations at the University Hospital of Zurich per year [1]. Although the diagnosis rarely poses a difficulty, its treatment can be quite troublesome and patients often inquire about preventive measures that could be taken.…”

The possible relationship between epistaxis and protein Z plasma levels

“…Sphenopalatine artery is responsible for most of the posterior epistaxis [3]. Bleeding caused by local traumas rather than anterior, whereas bleeding caused by systemic diseases usually generate from the posterior [3,4].…”