Epistaxis: when are coagulation studies justified?

Epistaxis is a common emergency in otolaryngology. There is some evidence questioning the use of routine coagulation studies (prothrombin time and activated partial thromboplastin time (APTT)) in these patients, but this practice continues in most centres.

To identify groups of patients likely to present with coagulation abnormalities.

Charts of all patients aged >14 years with epistaxis, requiring admission to Aga Khan University Hospital, Karachi, Pakistan, through the emergency department between January 2002 and December 2005, were retrospectively reviewed for the presence of comorbid conditions and coagulation abnormalities. Deranged coagulation was defined as an APTT of >7 s above control or an international normalised ratio >1.5. Analysis was carried out using SPSS V.13.0.

All 108 patients were included in the study (male patients, 71.3%; female patients, 28.7%; mean age 40.4 years). Only 49 patients had an associated condition that could potentially cause epistaxis. Of these, the coagulation profiles of 10 patients were deranged, which included 6 patients receiving anticoagulant treatment, 2 with chronic active hepatitis, 1 with liver cancer and 1 with haemophilia.

Routine coagulation screening of all patients with epistaxis is of little value and only adds to treatment costs and emergency room occupancy times. Comorbid conditions such as hypertension or cases with thrombocytopenia do not merit coagulation screening. However, coagulation studies are justified in patients receiving anticoagulant treatment and those with known coagulopathy or chronic liver disease.