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Inicio Gastroenterología y Hepatología (English Edition) Epistaxis in the cirrhotic patient: A complication to be considered
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Vol. 42. Issue 1.
Pages 11-15 (January 2019)
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Vol. 42. Issue 1.
Pages 11-15 (January 2019)
Original article
DOI: 10.1016/j.gastre.2019.01.012
Epistaxis in the cirrhotic patient: A complication to be considered
Epistaxis en el paciente cirrótico: una complicación a tener en cuenta
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Carlos Ferre Aracil
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carlos.ferre@salud.madrid.org

Corresponding author.
, Laura Núñez Gómez, Luis Téllez Villajos, Agustín Albillos Martínez
Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Table 1. Main comorbidities of the patients enrolled in the study (N=39).
Abstract
Introduction

Epistaxis in cirrhotic patients is a common issue. However, the literature published to date is very scarce.

Material and methods

Retrospective case series of patients with cirrhosis who presented with a significant epistaxis, between 2006 and 2016.

Results

Data were collected from 39 cirrhotic patients with a mean age of 61.4 (±14) years, 75% of which were males. The main comorbidities were hypertension (33%) and diabetes mellitus (26%). Seven (18%) patients were taking antiplatelet drugs and 3 (8%) anticoagulants. One third of patients had a previous history of epistaxis and 6 had a previous ENT pathology. The main aetiological factor of cirrhosis was alcohol in 46% of cases, with 15 (38%) patients presenting with Child A, 12 (31%) Child B and 12 (31%) Child C class. The median MELD score upon admission was 16 [12–21]. Thirty-five (97%) patients had portal hypertension. At admission, the median platelet count was 89,000 [60,000–163,000] and mean INR was 1.52 (±0.37). Clinically, epistaxis presented as haematemesis or melaena in 8 (21%) patients, simulating gastrointestinal bleeding due to swallowing of blood. In 10 (26%) patients, epistaxis was considered as the probable trigger of an episode of hepatic encephalopathy. Two patients required ICU admission due to bleeding and 8 (21%) died during hospitalisation due to causes not directly related to epistaxis.

Conclusions

Epistaxis is a complication to be taken into account in cirrhotic patients, as it can act as an encephalopathy trigger or simulate an episode of gastrointestinal bleeding.

Keywords:
Cirrhosis
Epistaxis
Chronic hepatopathy
Nosebleed
Resumen
Introducción

La epistaxis en los pacientes cirróticos es un hecho frecuente. No obstante, la literatura publicada hasta la fecha es muy escasa.

Material y métodos

Serie de casos retrospectiva de pacientes con cirrosis que presentaron una epistaxis significativa, entre los años 2006 y 2016.

Resultados

Se recogieron datos de 39 pacientes cirróticos con una edad media de 61,4 (±14) años, 75% varones. Las principales comorbilidades fueron la hipertensión arterial (33%) y la diabetes mellitus (26%). Siete (18%) pacientes tomaban antiagregantes y 3 (8%) anticoagulantes. Un tercio de los pacientes tenían antecedentes de epistaxis y 6 presentaban alguna patología ORL previa. La principal etiología de la cirrosis fue el alcohol en el 46% de los casos, siendo 15 (38%) pacientes Child A, 12 (31%) Child B y 12 (31%) Child C. La mediana de MELD al ingreso fue de 16 [12-21]. Treinta y cinco (97%) pacientes presentaban hipertensión portal. Al ingreso, la mediana de plaquetas fue de 89.000 [60.000-163.000] y la media de INR de 1,52 (±0,37). Clínicamente, en 8 (21%) pacientes la epistaxis se presentó simulando una hemorragia digestiva como hematemesis o melenas al ser la sangre deglutida. En 10 (26%) pacientes la epistaxis fue considerada como el probable desencadenante de una encefalopatía hepática. Dos pacientes requirieron ingreso en UCI por el sangrado y 8 (21%) fallecieron durante el ingreso, por causas no directamente relacionadas con la epistaxis.

Conclusiones

La epistaxis es una complicación a tener en cuenta, pudiendo actuar como desencadenante de encefalopatía o simular un episodio de hemorragia digestiva.

Palabras clave:
Cirrosis
Epistaxis
Hepatopatía crónica
Sangrado nasal

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