SPONTANEOUS HEMORRHAGE: A Clinical Entity, with Special Reference to Epistaxis

Treatment of Diabetic Retinopathy With Estrogens

“…Other possible hemostatic mechanisms of estrogen therapy include a serotonin‐like action and the neutralization of a vascular toxin (70).…”

Oral and Intravenous Estrogens in the Treatment and Prevention of Bleeding Associated With Long‐term Anticoagulant Therapy

“…That there are several potential facets of such action is suggested by the value of intravenous and oral estrogens in the treatment of massive gastro‐intestinal hemorrhage associated with portal hypertension (30), recurrent intra‐ocular hemorrhage associated with diabetic retinopathy (31), epistaxis associated with hemorrhagic telangiectasia (44, 45), corticosteroid‐induced ecchymoses (46), delayed post‐traumatic hemorrhage, functional uterine bleeding, and bleeding following tonsillectomy, prostatectomy and ophthalmic surgery (47–50). The case of an elderly hemophiliac in whom massive hemorrhage following dental extraction was uncontrollable until the administration of estrogens intravenously is also on record (51).…”

“…The following are clinical examples: (a) The author and others (44, 45) have observed the suppression of recurrent epistaxis in hemorrhagic telangiectasia, both cyclically in relation to the menses and following the oral and parenteral administration of estrogens. (b) Massive spontaneous epistaxis not responding to anterior and posterior packing, vitamin C, vitamin K, ice packs, thrombin and fibrin foam, subsequently controlled by intravenous estrogens (44, 47); following the arrest of epistaxis by estrogen therapy, the open vessel still can be seen even though no blood is escaping (47, 48); concomitantly, there is a change in the color of the congested cyanotic vessels to a more normal hue. (c) A colleague (56) has repeatedly been able to terminate bouts of hemoptysis in a patient with mitral stenosis by intravenous administration of Premarin.…”

Estrogenic Control of Corticosteroid‐induced Bruising, With a Commentary on Estrogen‐corticosteroid Interrelationships

“…Suppression of recurrent epistaxis has been noted in hemorrhagic telangiectasia, both cyclically in relationship to the menses and following the oral and parenteral administration of estrogens (19–21) ( vide infra ). There have been instances in which spontaneous massive epistaxis has not responded to packing, vitamin C, vitamin K, ice packs, thrombin and fibrin foam, yet control was promptly achieved by intravenous injection of estrogens (40). In a patient with severe thrombocytopenia and anemia due to pentachlorophenol‐induced aplasia of the marrow, the writer was able to control widespread hemorrhages into the skin and mucous membranes for five months by means of one or several injections of Premarin Intravenous daily—even when transfusions of fresh blood proved ineffective (19).…”

“…There is reason to believe that the enhanced resorption of hemorrhagic residues following administration of estrogens—particularly in cases of acute intraocular bleeding—is explainable in part by an effect upon some spreading factor (17, 41). Other mechanisms proposed to explain the hemostatic action of estrogen therapy include serotonin‐like activity, and the neutralization of a vascular toxin comparable to “menotoxin” (51).…”