Management of Upper Airway Bleeding in Patients Hospitalized for SARS-COV2

Spontaneous epistaxis in patients with COVID-19 can represent a clinical challenge with respect to both the risk of contamination and the treatment options. Epistaxis (nosebleed) is a common condition overall but is relatively rare in adults and older patients. We herein present the data of 25 patients with COVID-19 who developed spontaneous epistaxis while hospitalized at Centro Médico Naval from March 2020 to April 2021. All patients received low-molecular-weight heparin during their hospital stay and required supplementary oxygen therapy either by a nasal cannula, continuous positive airway pressure or ventilatory mechanical support. In total, 12100 patients with laboratory confirmed SARS-CoV-2 infection were admitted to our hospital unit from 1 March to 31 April 2021. We only found 25 patients with epistaxis, All patients underwent anterior rhinoscopy. In all patients, the bleeding site was identified, controlled with cauterization with silver nitrate and absorbable hemostatic material. In patients with posterior epistaxis, the posterior packing was removed after 5 days. Nasal lubricants were prescribed in all patients after bleeding was controlled. All patients required suspension of anticoagulation after the bleeding event for 48 hours. Posterior, anterior and oropharyngeal epistaxis occurred in both sexes, in patients with comorbidities (Diabetes mellitus, hypertension, obesity) without statistical difference. In those patients who were on ventilatory mechanical support, they presented the same risk of epistaxis, however, with a small tendency to present greater anterior epistaxis, in the same way, those patients who presented anterior epistaxis had higher mortality.