From the Guidelines
Epistaxis, or nosebleed, is primarily caused by local factors such as trauma, nasal dryness, and septal abnormalities, as well as systemic factors including hypertension, blood disorders, and medications like anticoagulants and antiplatelet drugs, as reported in the most recent clinical practice guideline by 1. The etiology of epistaxis can be categorized into local and systemic factors. Local causes include:
- Trauma (nose picking, facial injury)
- Nasal dryness
- Foreign bodies
- Inflammatory conditions
- Septal abnormalities
- Tumors Systemic causes encompass:
- Hypertension
- Blood disorders like hemophilia or thrombocytopenia
- Liver disease
- Kidney disease
- Medications such as anticoagulants (warfarin, heparin), antiplatelet drugs (aspirin, clopidogrel), and NSAIDs, as noted in 1 and 1. Environmental factors like low humidity, high altitude, and seasonal allergies can also contribute to epistaxis, as mentioned in 1. Most nosebleeds originate from the anterior nasal septum in an area called Kiesselbach's plexus, where multiple blood vessels converge, as stated in 1. Understanding these etiologies is crucial for guiding appropriate management, from simple pressure application for minor bleeds to medical or surgical interventions for more complex cases, as emphasized in the clinical practice guideline by 1. Age-related vascular changes make epistaxis more common in children and older adults, highlighting the need for tailored management approaches based on patient demographics and underlying health conditions, as discussed in 1 and 1.
From the Research
Epistaxis Etiology
- Epistaxis, or nasal bleeding, can have various causes, including both local and systemic processes 2
- The condition can originate from either the anterior or posterior nasal cavity, but it most often occurs in the anterior nasal cavity 2
- A directed history and physical examination can generally determine the cause of the bleeding 2
- Local factors that may contribute to epistaxis include:
- Dry air or nasal trauma
- Nasal infections or inflammation
- Tumors or other nasal abnormalities
- Systemic factors that may contribute to epistaxis include:
- Bleeding disorders or coagulopathy
- Hypertension or other cardiovascular conditions
- Medications that affect blood clotting or vessel integrity
- The exact cause of epistaxis may not always be determined, but treatment can often be effective in controlling the bleeding 2, 3