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Risk factors for recurrent spontaneous epistaxis.
Victor Abrich1, Annabelle Brozek1, Timothy R Boyle2
1Department of Internal Medicine, Marshfield Clinic, Marshfield, WI.
Mayo Clinic Proceedings
|December 3, 2014
Summary
Congestive heart failure, hypertension, and diabetes mellitus are significant risk factors for recurrent nosebleeds (epistaxis). Physicians should balance bleeding risks with preventing major cardiovascular events when prescribing blood thinners.
Area of Science:
- Otolaryngology
- Cardiology
- Internal Medicine
Background:
- Recurrent spontaneous epistaxis is a common clinical problem.
- Identifying associated risk factors is crucial for patient management and prevention.
Purpose of the Study:
- To identify risk factors associated with spontaneous recurrent epistaxis.
- To investigate the relationship between medical comorbidities and recurrent nosebleeds.
Main Methods:
- Retrospective cohort study of 461 patients with recurrent epistaxis and 912 controls.
- Investigated over 50 potential risk factors using Cox proportional hazards regression.
- Analyzed demographic features, substance use, nasal abnormalities, infections, comorbidities, medications, and lab values.
Main Results:
- Traditional nasal factors (e.g., septal deviation, sinusitis) did not increase recurrence risk.
- Significant risk factors for recurrent epistaxis included congestive heart failure, diabetes mellitus, hypertension, and anemia.
- Warfarin use increased recurrence risk; aspirin and clopidogrel did not.
Conclusions:
- Congestive heart failure is an underappreciated risk factor for recurrent epistaxis.
- Hypertension and diabetes may contribute to nasal vessel friability.
- Physicians must balance epistaxis risk with the need for antiplatelet/antithrombotic therapy to prevent cardiovascular events.
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