# Use of Blood Thinners and Increased Nosebleeds during the Coronavirus Disease 2019 Pandemic

## TL;DR

The study found that during the pandemic, more patients with nosebleeds were using blood thinners, suggesting a link between COVID-19 and increased nosebleeds.

## Contribution

This study is one of the first to correlate increased nosebleeds in a hospital with the use of anticoagulants during the pandemic.

## Key findings

- There were 61 cases of COVID-19-related nosebleeds with an average of 12 cases per month during the pandemic peak.
- 90.17% of patients with nosebleeds were using anticoagulants like heparin, enoxaparin, or rivaroxaban.

## Abstract

Introduction
 In May 2020, the World Health Organization declared Brazil a new epicenter of the coronavirus pandemic.

Objective
 The present study aims to verify if the frequency of nasal bleeding and/or epistaxis in patients of a tertiary hospital was correlated with the pandemic of coronavirus disease 2019 (COVID-19) and with the use of anticoagulants.

Methods
 The analysis performed was retrospective from the database of the otorhinolaryngology service of a Brazilian tertiary hospital, comparing 2 periods: 1 from March 2020 to July 2021 comprising the peak of pandemic setting, and another from August 2021 to May 2022. We checked data on the average number of cases/month and on the use of anticoagulants.

Results
 In the period above mentioned, there were 61 cases of COVID-19-related epistaxis (from a total of 180 cases of nasal bleeding and/or epistaxis), with an average of 12 cases/month, demonstrating an increase in the frequency of cases at the institution, when compared to a study involving 343 cases from the same institution over a period of 42 months (October 2015–March 2019), in which the average was 8.1 cases/month. Among the patients with COVID-19 and nasal bleeding, 55 (90.17%) were using some type of anticoagulant at the time of bleeding: 41% were on subcutaneous heparin; 20% were on subcutaneous enoxaparin; 16.66% were receiving intravenous heparin on continuous infusion bomb (CIB); 6.66% were on extracorporeal membrane oxygenation (ECMO) associated with intravenous heparin on CIB; 4.99% were on oral rivaroxaban; and 1.66% are on oral apixaban.

Conclusion
 Our study's data confirmed the increase in the number of epistaxis cases and the use of anticoagulants in COVID-19 patients.