Recurrent bleeding in the case of epistaxis

Introduction:

Nose bleeding is a common reason for a consultation in the emergency department. Recurrent bleeding can be a threatening situation.

Methods:

There was a retrospective evaluation of 720 patients data to identify predictors and risk factors for recurrent nose bleeding. Only cases with a need for a hospitalisation were included. A recurrent bleeding was defined as a bleeding within 30 days after dismissal with another hospitalisation. A severity-score was calculated to express the heaviness of the nose bleeding.

Results:

There was a calculated incidence of 4,7% to have a recurrent nose bleeding. The sex had no influence. An age over 70 years and multimorbidity could be detected as risk factors. Specific diseases had no influence. The severity-score was twice as high in the group of recurrent bleeding. There was a positive correlation with the invasiveness of the treatment. A combination of antiplatelet and anticoagulant increased the risk of recurrent nose bleeding, even if not significant. Overdoses with antagonist of vitamin K and therefore a fluctuating INR is also a non-significant risk factor.

Discussion:

The incidence of recurrent nose bleeding in this study was really small in contrast to the literature. One explanation may be the different definitions of recurrent nose bleeding. Another one may be the design of the study, that only cases with hospitalisation were included. Because of the shown increasing risk due to the combination of antiplatelet and anticoagulant, even if not significant, there should be a well-considered prescription. Significant risk factors were an age over 70 years and multimorbidity. In the case of a recurrent nose bleeding there was a mainly operative therapy without an increasing rate of complications or lethality.

Publication History

Publication Date:
18 April 2018 (online)