Epistaxis in Patients Receiving Oral Anticoagulants and Antiplatelet: Prevalence Risk Factors At a Tertiary Care Hospital in Nepal

Study Design and duration This study employed a hospital-based observational, cross-sectional design to determine the prevalence of epistaxis and identify the associated factors among patients on oral anticoagulants and antiplatelet medications at a tertiary care hospital in Nepal. The study was conducted at the department of emergency and ENT over a one-year period, from November 2023 to October 2024.

Study Setting and justification The study was conducted at the department of emergency and Ear Nose Throat (ENT) of Tribhuvan university teaching hospital (TUTH), Institute of Medicine (IOM), a tertiary care hospital of Nepal's premier healthcare institutions, situated in the heart of the capital city, Kathmandu. TUTH stands as the top referral hospital in the country and a public hospital in Kathmandu with 850 beds, which is recognized hospitals of Nepal with a good flow of patients from all over Nepal, making it easier to recruit a sufficient number of representing cases for the study. This hospital serves a diverse patient population across the country from both urban and rural areas, making an ideal setting for the representative samples to study on the prevalence and risk factors associated with epistaxis in patients taking anticoagulants and antiplatelet medications.

Study Population and selection criteria Inclusion and exclusion criteria The study included individuals aged 40 years or older who had been prescribed oral anticoagulants or antiplatelet agents for at least 3 months. Patients were excluded if they had a known bleeding disorder unrelated to the use of anticoagulant or antiplatelet medication, a history of coagulopathy or other bleeding disorders (e.g., hemophilia), recent craniofacial or nasal trauma or surgery within the past 6 months, a known history of nasal polyps or other nasal lesions, or if they declined to provide consent.

Variables of interest In this study, age, gender, residency, social habits, underlying medical conditions, types of anticoagulant and antiplatelet medications, and the duration of medication use were identified as exposure variables; whereas, the prevalence, severity, and frequency of epistaxis were evaluated as outcome variables.

Sample Size Determination