Antithrombotic-antiplatelet and anticoagulant-drugs may be a predisposing factor for epistaxis in the elderly.
Temporary discontinuation of antithrombotic drugs trigger ischemic events, such as myocardial infarction, cerebral infarction, and transient ischemic attack (TIA), which are often difficult to predict.
A 64-year-old man taking aspirin for myocardial infarction was seen shortly after developing epistaxis from the left nasal cavity. The nasal septum deviated into the left, and the epistaxis came from behind it.
Coagulation tests were within the normal range.but the man had slight anemia. Gauze with paste was inserted for angiopressure. Aspirin was stopped to avoid rebleeding, and he was hospitalized for bedrest. Numbness and decreased right-hand grip seen 5 days after admission disappeared after 4 hours. Aspirin was restarted these transient symptoms indicated a TIA. No abnormal findings were seen in head head CT or MRI. No further epistaxis or TIA symptoms were seen and the man was discharged the next day.
This case makes 3 important points: coagulability must be assessed before treatment, the antithrombotic drug amounts should be monitored, and timing for re-starting antithrombotic drugs must be considered.