Hello.

Thanks for the query

Nasal bleeding is because of various causes such as increased blood pressure, drugs (such as anti-coagulants and platelet inhibitors), change of weather, sinusitis, nasal allergy, etc.

In the case of your wife, the nasal bleed could be because of warfarin (anticoagulant) and any trivial damage to the nasal mucosa can cause bleeding. Warfarin is like a 'double-edged sword', it prevents clotting as well as increase bleeding. I do understand that warfarin is required for the post stroke patients to prevent clotting of the blood, but at the same time it can lead to frequent nasal and oral cavity bleeds.

Nasal bleeding occurring just by bending forward is because of pooling of the blood in the most dependent part and oozing out through the weak or damaged blood vessels. More over she is suffering from Hay fever also, which is another reason for the pooling of the blood in the nasal mucosa.

So, the next line of management is to get angiography done to look for the bleeding points in the nose. Once the bleeding points or aneurysms (weak regions in the wall of the blood vessels) are noticed, the chief supplying vessel can be either clipped or embolized.

I do understand your apprehension, but the doctors are left with very few choices, as your wife is suffering from multiple medical problems.

Hope I have answered your query. I will be available for the follow-up queries.

Regards.

Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

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