Use of Blood Thinners and Increased Nosebleeds during the Coronavirus Disease 2019 Pandemic

Introduction  In May 2020, the World Health Organization declared Brazil a new epicenter of the coronavirus pandemic. Objective  The present study aims to verify if the frequency of nasal bleeding and/or epistaxis in patients of a tertiary hospital was correlated with the pandemic of coronavirus disease 2019 (COVID-19) and with the use of anticoagulants. Methods  The analysis performed was retrospective from the database of the otorhinolaryngology service of a Brazilian tertiary hospital, comparing 2 periods: 1 from March 2020 to July 2021 comprising the peak of pandemic setting, and another from August 2021 to May 2022. We checked data on the average number of cases/month and on the use of anticoagulants. Results  In the period above mentioned, there were 61 cases of COVID-19-related epistaxis (from a total of 180 cases of nasal bleeding and/or epistaxis), with an average of 12 cases/month, demonstrating an increase in the frequency of cases at the institution, when compared to a study involving 343 cases from the same institution over a period of 42 months (October 2015-March 2019), in which the average was 8.1 cases/month. Among the patients with COVID-19 and nasal bleeding, 55 (90.17%) were using some type of anticoagulant at the time of bleeding: 41% were on subcutaneous heparin; 20% were on subcutaneous enoxaparin; 16.66% were receiving intravenous heparin on continuous infusion bomb (CIB); 6.66% were on extracorporeal membrane oxygenation (ECMO) associated with intravenous heparin on CIB; 4.99% were on oral rivaroxaban; and 1.66% are on oral apixaban. Conclusion  Our study's data confirmed the increase in the number of epistaxis cases and the use of anticoagulants in COVID-19 patients.