Key result
Low-dose aspirin is linked to ~9-fold higher epistaxis risk vs. no antiplatelet therapy.
Why the study?
The relative risk of epistaxis associated with low-dose aspirin or clopidogrel compared to no drug was not quantified.
Case-Control (n=10,241)
Yes
May warrant epistaxis vigilance with low-dose aspirin or clopidogrel; leaves open causality and comparative risks in prospective studies.
OBJECTIVES: To quantify the relative risk of epistaxis for patients taking low-dose aspirin or clopidogrel compared to patients taking neither drug. DESIGN: Case-control study. SETTING: Primary care. PARTICIPANTS: 10,241 patients from three GP practices in the West Midlands. MAIN OUTCOME MEASURES: Epistaxis resulting in presentation to the GP, attendance at Accident & Emergency, or referral to ENT outpatients. RESULTS: There was a significant difference in the proportion of patients with epistaxis across the three groups (chi(2) = 84.1; 2 degrees of freedom; P < 0.000001). Relative risk of epistaxis was increased in both the aspirin (RR = 9.04; 95% CI = 5.13-15.96) and clopidogrel (RR = 6.40; 95% CI = 2.33-17.56) groups compared to the no drug group. There was no increased risk of epistaxis with aspirin compared to clopidogrel (RR = 1.4; 95% CI = 0.6-3.4). CONCLUSION: There is an increased risk of troublesome epistaxis in patients taking aspirin or clopidogrel. There is no significant difference in risk of epistaxis between the two drug groups.
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Rainsbury et al. (2009) reported a case-control. Low-dose aspirin or clopidogrel vs. Neither drug was evaluated on Epistaxis resulting in presentation to the GP, attendance at Accident & Emergency, or referral to ENT outpatients (RR 9.04, 95% CI 5.13-15.96, p=<0.000001). Low-dose aspirin and clopidogrel were associated with an increased risk of epistaxis compared to no drug (RR 9.04 and 6.40, respectively), with no significant difference between the two (RR 1.4).
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