Intranasal oestrogen cream for the prevention of epistaxis in patients with bleeding disorders
(Impact Factor: 2.6).
01/2011; 17(1):164. DOI: 10.1111/j.1365-2516.2010.02356.x
Available from: PubMed Central
- "Atherosclerosis has been identified as an aetiological factor in epistaxis5,6 and it has been proposed that the hormonal state of the menstruating female, while protecting against cardiovascular disease in general,12,13 can also protect the vasculature of the nasal mucosa. Further evidence of the effect of female sex hormones on the nasal mucosa is demonstrated by the reported use of topical oestrogen for recurrent epistaxis in patients with bleeding disorders.14 The possibility is also raised that the use of oestrogen containing oral contraceptives in this age group may further promote a reduction in epistaxis rates, possibly due to their prothrombotic effects.15 "
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ABSTRACT: Epistaxis is the one of the most common otorhinolaryngology emergencies. This study examined the age and sex distribution of all patients admitted with epistaxis to National Health Service (NHS) hospitals in Wales, UK, over a period of 18 years and 9 months.
The Patient Episode Database for Wales was examined for all patient admissions with a diagnosis of epistaxis between April 1991 and December 2009. The age and sex of these patients was recorded and the proportion of the underlying population affected was calculated by comparing admission rates to the population data derived from the 1991 and 2001 national population censuses for Wales.
A total of 26,725 patients were admitted to NHS hospitals in Wales with epistaxis over the period studied. The proportion of the population admitted with epistaxis increased from the age of 40 onwards. For all ages except patients in the 10-14 years group, a higher proportion of the male population was admitted with epistaxis than the comparable female population. This discrepancy was most pronounced between the ages of 15 and 49 years, with the female-to-male ratio of hospital admissions with epistaxis being 0.55. These ages (15 and 49 years) approximate the average age of menarche and menopause respectively in the UK.
Women of menstrual age have fewer hospital admissions with epistaxis. This may be due to oestrogens providing protection to the nasal vasculature (as they do to other areas of the vascular tree).
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ABSTRACT: Bleeding disorders are broadly classified into primary and secondary hemostatic defects. Primary hemostatic disorders (disorders of platelets and von Willebrand factor) mainly result in mucocutaneous bleeding symptoms such as epistaxis, menorrhagia, petechiae, easy bruising, and bleeding after dental and surgical interventions. Secondary hemostatic disorders (congenital or acquired deficiencies of coagulation factors) typically manifest with delayed, deep bleeding into muscles and joints. This article provides a generalized overview of the pathophysiology, clinical manifestations, laboratory abnormalities, and molecular basis of inherited abnormalities of coagulation with a focus on hemophilia, von Willebrand disease, and rare inherited coagulation disorders.
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