Epistaxis

Persistence of bleeding

Typical epistaxis:

• Usually less profuse and responds to pressure, vasoconstrictor application, cautery, or nasal packing.

Recalcitrant epistaxis:

• May be more profuse, with persistent bleeding despite nasal packing

• More likely to occur in the context of an underlying coagulopathy, resulting in bleeding that is recalcitrant to all the normal measures

• Possible causes of coagulopathy include primary disorders of coagulation (e.g., hemophilia), liver disease, and medications that impair clotting (e.g., warfarin, aspirin, nonsteroidal anti-inflammatory drugs)

• Abnormal blood vessels; for example, patients with hereditary hemorrhagic telangiectasia have more frequent and more persistent epistaxis.