Based on the observation of 65 patients admitted for epistaxis from July 2000 to June 2007, we noted a higher frequency in men than women (male/female ratio about 2 to 1), a higher incidence among the middle-aged and olderly than in younger patients, and a higher epistaxis frequency in winter.
Among subjects, 25 (38.5%) had bleeding in Kisselbach's area, 13 (20%) in the inferior turbinate or meatus, 7 (10.8%) in the middle turbinate or meatus, 5 (7.7%) in the olfactory cleft, 1 (1.5%) in the bottom of the common nasal meatus, 1 (1.5%) in the posterior nasal septum, and 13 (20%) at unidentifiable sites. All were treated with gauze packing. Ten patients (15.4%) were treated with postnasal packing using Belloq's tampon or epistaxis balloon. None underwent surgical arterial ligation or arterial embolization.
Complications seen in 51 (78.5%) included hypertension, heart disease, liver disease, diabetic mellitus, postoperative heart disease (artificial valve replacement), and chronic renal failure. Anticoagulation therapy was conducted for 18 (27.7%) and wafarin therapy for 11 (16.9%). Epistaxis that complicates warfarin therapy is becoming increasingly common. Prothrombin time (international normalized ratio: INR) was measured routinely and ranged from 1.3 to 3.8, averaging 2.23. In all patients but one, warfarin was stopped temporarily until epistaxis was controlled. No thromboembolic complications occurred.
When epistaxis is encountered in the elderly, it thus becomes to consider both local treatment for epistaxis and the possibility of systemic disease.
