Epistaxis: when are coagulation studies justified?

Area of Science:

• Otolaryngology
• Emergency Medicine
• Hematology

Background:

• Epistaxis is a frequent otolaryngology emergency.
• Routine coagulation studies (prothrombin time, activated partial thromboplastin time) are commonly performed but their utility is questioned.
• This practice persists despite evidence suggesting limited value.

Purpose of the Study:

• To identify patient groups at higher risk for coagulation abnormalities presenting with epistaxis.
• To evaluate the necessity of routine coagulation screening in all epistaxis patients.

Main Methods:

• Retrospective chart review of 108 adult patients admitted with epistaxis.
• Data collected included comorbid conditions and coagulation status.
• Deranged coagulation defined as APTT >7s above control or INR >1.5.

Main Results:

• Only 49 patients had conditions potentially causing epistaxis.
• Ten patients (9.3%) had deranged coagulation profiles.
• Deranged coagulation was observed in patients on anticoagulants, with chronic active hepatitis, liver cancer, or hemophilia.

Conclusions:

• Routine coagulation screening for all epistaxis patients offers little diagnostic value and increases healthcare costs.
• Coagulation studies are not indicated for patients with hypertension or thrombocytopenia.
• Screening is justified for patients on anticoagulant therapy or with known coagulopathy or chronic liver disease.