Epistaxis Causes and Associations

Medications That Increase Nosebleed Risk

• The American Academy of Otolaryngology-Head and Neck Surgery recommends that anticoagulants and antiplatelet agents, such as warfarin, rivaroxaban, dabigatran, aspirin, and clopidogrel, be recognized as substantial risk factors for epistaxis, with increased risk and severity 1, 2
• The use of intranasal corticosteroids is associated with a significantly increased risk of nosebleeds, with a relative risk of 2.74 (range 1.88-4.00) compared to placebo, according to the American Academy of Otolaryngology-Head and Neck Surgery 1, 2, 3
• Intranasal vasoconstrictors, such as oxymetazoline, can cause nasal dryness and bleeding with repeated use, as stated by the American Academy of Otolaryngology-Head and Neck Surgery 4, 5, 6

Diagnostic Considerations for Nosebleeds

• If a patient on acetazolamide develops nosebleeds, the American Academy of Otolaryngology-Head and Neck Surgery suggests looking for alternative explanations, such as concurrent use of anticoagulants or antiplatelet drugs, intranasal corticosteroid use, local trauma or environmental factors, underlying bleeding disorders, or hypertension 1, 2, 7