Intractable epistaxis with febuxostat

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: To report a case of serious, intractable epistaxis warranting an emergency department (ED) visit and hospital admission for transfusion following initiation of febuxostat.Case Summary: An 86-year-old female presented to the ED after onset of intractable epistaxis for the previous 24 hours. Medications included aspirin, clopidogrel, metoprolol tartrate, valsartan, rosuvastatin, levothyroxine, esomeprazole, and febuxostat. She was treated with prednisone in the ED for a gout flare 3 weeks prior to the current visit, then was started on febuxostat at her follow-up primary care visit. Ten days after starting febuxostat therapy, she had onset of epistaxis. Initial treatment did not provide hemostasis and hemoglobin, and hematocrit values decreased. She was admitted and transfused. Aspirin, clopidogrel, and febuxostat were held during hospitalization. Bleeding subsided following bedside cautery. On hospital day 3, she restarted aspirin and clopidogrel and was discharged with no recurrence of bleeding.Discussion: Epistaxis is relatively common and can be caused by multiple etiologies. Patient did not have prior episodes of epistaxis and had been on all medications for more than a year, except for febuxostat. This patient was also taking aspirin and clopidogrel; however, she had been taking these agents concomitantly for at least 4 years with no prior report of bleeding. Epistaxis occurred 10 days after the first dose of febuxostat with no other reported changes.Conclusions: Epistaxis due to febuxostat use cannot be ruled out. Clinicians may consider alternate gout therapy in patients at high risk or taking medications that increase their risk for bleeding.

Original languageEnglish (US)
Pages (from-to)460-462
Number of pages3
JournalHospital Pharmacy
Volume47
Issue number6
DOIs
StatePublished - Jun 1 2012

Fingerprint

Epistaxis
clopidogrel
Aspirin
Hemorrhage
Hospital Emergency Service
Gout
Valsartan
Esomeprazole
Cautery
Aftercare
Metoprolol
Febuxostat
Risk-Taking
Prednisone
Hemostasis
Thyroxine
Hematocrit
Primary Health Care
Hemoglobins
Hospitalization

All Science Journal Classification (ASJC) codes

  • Pharmacy
  • Pharmacology
  • Pharmacology (medical)

Cite this

Intractable epistaxis with febuxostat. / Chamberlin, Shaunta'; Hall, Monte D.; Barger-Stevens, Amy.

In: Hospital Pharmacy, Vol. 47, No. 6, 01.06.2012, p. 460-462.

Research output: Contribution to journalArticle

Chamberlin, Shaunta' ; Hall, Monte D. ; Barger-Stevens, Amy. / Intractable epistaxis with febuxostat. In: Hospital Pharmacy. 2012 ; Vol. 47, No. 6. pp. 460-462.
@article{addc488e4dd64e69a102cdfc0736cf70,
title = "Intractable epistaxis with febuxostat",
abstract = "Objective: To report a case of serious, intractable epistaxis warranting an emergency department (ED) visit and hospital admission for transfusion following initiation of febuxostat.Case Summary: An 86-year-old female presented to the ED after onset of intractable epistaxis for the previous 24 hours. Medications included aspirin, clopidogrel, metoprolol tartrate, valsartan, rosuvastatin, levothyroxine, esomeprazole, and febuxostat. She was treated with prednisone in the ED for a gout flare 3 weeks prior to the current visit, then was started on febuxostat at her follow-up primary care visit. Ten days after starting febuxostat therapy, she had onset of epistaxis. Initial treatment did not provide hemostasis and hemoglobin, and hematocrit values decreased. She was admitted and transfused. Aspirin, clopidogrel, and febuxostat were held during hospitalization. Bleeding subsided following bedside cautery. On hospital day 3, she restarted aspirin and clopidogrel and was discharged with no recurrence of bleeding.Discussion: Epistaxis is relatively common and can be caused by multiple etiologies. Patient did not have prior episodes of epistaxis and had been on all medications for more than a year, except for febuxostat. This patient was also taking aspirin and clopidogrel; however, she had been taking these agents concomitantly for at least 4 years with no prior report of bleeding. Epistaxis occurred 10 days after the first dose of febuxostat with no other reported changes.Conclusions: Epistaxis due to febuxostat use cannot be ruled out. Clinicians may consider alternate gout therapy in patients at high risk or taking medications that increase their risk for bleeding.",
author = "Shaunta' Chamberlin and Hall, {Monte D.} and Amy Barger-Stevens",
year = "2012",
month = "6",
day = "1",
doi = "10.1310/hpj4706-460",
language = "English (US)",
volume = "47",
pages = "460--462",
journal = "Hospital Pharmacy",
issn = "0018-5787",
publisher = "Facts and Comparisons",
number = "6",

}

TY - JOUR

T1 - Intractable epistaxis with febuxostat

AU - Chamberlin, Shaunta'

AU - Hall, Monte D.

AU - Barger-Stevens, Amy

PY - 2012/6/1

Y1 - 2012/6/1

N2 - Objective: To report a case of serious, intractable epistaxis warranting an emergency department (ED) visit and hospital admission for transfusion following initiation of febuxostat.Case Summary: An 86-year-old female presented to the ED after onset of intractable epistaxis for the previous 24 hours. Medications included aspirin, clopidogrel, metoprolol tartrate, valsartan, rosuvastatin, levothyroxine, esomeprazole, and febuxostat. She was treated with prednisone in the ED for a gout flare 3 weeks prior to the current visit, then was started on febuxostat at her follow-up primary care visit. Ten days after starting febuxostat therapy, she had onset of epistaxis. Initial treatment did not provide hemostasis and hemoglobin, and hematocrit values decreased. She was admitted and transfused. Aspirin, clopidogrel, and febuxostat were held during hospitalization. Bleeding subsided following bedside cautery. On hospital day 3, she restarted aspirin and clopidogrel and was discharged with no recurrence of bleeding.Discussion: Epistaxis is relatively common and can be caused by multiple etiologies. Patient did not have prior episodes of epistaxis and had been on all medications for more than a year, except for febuxostat. This patient was also taking aspirin and clopidogrel; however, she had been taking these agents concomitantly for at least 4 years with no prior report of bleeding. Epistaxis occurred 10 days after the first dose of febuxostat with no other reported changes.Conclusions: Epistaxis due to febuxostat use cannot be ruled out. Clinicians may consider alternate gout therapy in patients at high risk or taking medications that increase their risk for bleeding.

AB - Objective: To report a case of serious, intractable epistaxis warranting an emergency department (ED) visit and hospital admission for transfusion following initiation of febuxostat.Case Summary: An 86-year-old female presented to the ED after onset of intractable epistaxis for the previous 24 hours. Medications included aspirin, clopidogrel, metoprolol tartrate, valsartan, rosuvastatin, levothyroxine, esomeprazole, and febuxostat. She was treated with prednisone in the ED for a gout flare 3 weeks prior to the current visit, then was started on febuxostat at her follow-up primary care visit. Ten days after starting febuxostat therapy, she had onset of epistaxis. Initial treatment did not provide hemostasis and hemoglobin, and hematocrit values decreased. She was admitted and transfused. Aspirin, clopidogrel, and febuxostat were held during hospitalization. Bleeding subsided following bedside cautery. On hospital day 3, she restarted aspirin and clopidogrel and was discharged with no recurrence of bleeding.Discussion: Epistaxis is relatively common and can be caused by multiple etiologies. Patient did not have prior episodes of epistaxis and had been on all medications for more than a year, except for febuxostat. This patient was also taking aspirin and clopidogrel; however, she had been taking these agents concomitantly for at least 4 years with no prior report of bleeding. Epistaxis occurred 10 days after the first dose of febuxostat with no other reported changes.Conclusions: Epistaxis due to febuxostat use cannot be ruled out. Clinicians may consider alternate gout therapy in patients at high risk or taking medications that increase their risk for bleeding.

UR - http://www.scopus.com/inward/record.url?scp=84861878425&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84861878425&partnerID=8YFLogxK

U2 - 10.1310/hpj4706-460

DO - 10.1310/hpj4706-460

M3 - Article

VL - 47

SP - 460

EP - 462

JO - Hospital Pharmacy

JF - Hospital Pharmacy

SN - 0018-5787

IS - 6

ER -