Significance of Coagulation Factors in Management of Idiopathic Epistaxis

Abstract

BACKGROUND Epistaxis or Bleeding from nose is one of the most common condition in ENT Department throughout the world, sometimes necessitating admission in hospital. 1 While attending the patient for the treatment of Epistaxis to control the bleeding, coagulation screening tests are ordered for in addition to routine blood investigations. But most of the times, epistaxis is due to no identifiable causes known as Idiopathic Epistaxis. In such scenario, the role of coagulation screening tests is unclear. An attempt is made to study whether there is any necessity of asking for coagulation screening tests. The objective is to study the need of coagulation screening tests in idiopathic epistaxis. MATERIALS AND METHODS The study was performed in patients attending casualty and OPD of Mahatma Gandhi Memorial Hospital, Kakathiya Medical College, Warangal, Telangana. The study was done for two years from August 2014 to July 2016. All the patients who attended casualty or outpatient department or admitted in ENT wards with spontaneous epistaxis were taken into the study. The exclusion criteria were history of trauma, local nasal pathology, systemic disorders like liver and kidney pathology, malignancy, history of bleeding disorders and patients on anticoagulant medications. All the patients were taken detailed history and examined clinically (ENT and General Examination). Complete blood picture including platelet count and BT, CT and coagulation screening with PT and APTT and INR was done for all the patients who were included in the study. Treatment modalities used to control epistaxis in these patients were electrocautery, anterior nasal packing and posterior nasal packing. RESULTS None of the patients with epistaxis had coagulation profile derangement. Out of 75 patients, 46 (61.33%) were discharged from Observation (OB) room of casualty after clinical and ENT examination. While 29 (38.66%) patients were admitted in ward for further management, out of these admitted patients 20 (68.96%) had bilateral Anterior Nasal Packing (ANP) done, 6 patients (20.68%) needed Posterior Nasal Packing (PNP) and 3 (10.34%) required Electrocauterisation (EC).