From the FDA Drug Label
Hemorrhage and necrosis have in some cases been reported to result in death or permanent disability. Bleeding results from the AMPLIFY study are summarized in Table 5. Adverse reactions related to bleeding occurred in 417 (15.6%) apixaban-treated patients compared to 661 (24.6%) enoxaparin/warfarin-treated patients.
There are recorded fatalities from hemorrhage, but no direct information is provided about fatalities specifically from epistaxis in patients on anticoagulants (blood thinners) 1 2.
From the Research
Yes, there are recorded fatalities from epistaxis in patients taking anticoagulants, though such deaths are rare. Patients on blood thinners like warfarin, apixaban (Eliquis), rivaroxaban (Xarelto), dabigatran (Pradaxa), and even aspirin or clopidogrel (Plavix) face increased risk of severe bleeding that can be difficult to control 3. Fatal outcomes typically occur when massive epistaxis leads to significant blood loss, airway compromise, or aspiration of blood. Elderly patients and those with multiple comorbidities are at highest risk. The mechanism involves the anticoagulant's intended effect of preventing clot formation, which becomes dangerous when bleeding occurs in areas with rich blood supply like the nasal mucosa.
Some key points to consider:
- Patients on these medications should seek immediate medical attention for severe or persistent nosebleeds, especially if they experience lightheadedness, weakness, or difficulty breathing.
- Emergency management may include temporary discontinuation of the anticoagulant, reversal agents in severe cases, nasal packing, and blood transfusions if necessary 4.
- The choice of anticoagulant may affect the severity and management of epistaxis, with some studies suggesting that factor Xa inhibitors may have a better outcome compared to warfarin or antiplatelet agents 3.
- The international normalized ratio (INR) may be used as a screening test for assessment of anticoagulant activity in patients treated with rivaroxaban or apixaban, although its validity has been questioned 5.
Overall, while fatalities from epistaxis in patients taking anticoagulants are rare, it is essential to be aware of the potential risks and to manage these patients promptly and effectively to minimize morbidity and mortality. Patients on anticoagulants should be closely monitored for signs of bleeding, and healthcare providers should be prepared to provide timely and appropriate treatment in case of epistaxis.