Getting nosebleeds or giant blood clots in the nose can be scary but most are actually harmless. Nosebleeds, or epistaxis, is a common problem that occurs in almost 60% of the population. A survey found that the two biggest groups of people who are more prone to have nosebleeds are children below the age of 10 and adults between 45 to 65 years of age. Interestingly, most patients with nosebleeds or blood clots in nose mucus are men, suggesting that women may have healthier nasal mucosa, probably due to the protective effect of estrogen.
Bleeding from the nose is divided into front (anterior) and back (posterior) nosebleeds, one of which tends to be more serious. Anterior nosebleeds originate from the front of the nose and result in blood flowing out from the nostrils. It is the most common type of nosebleed and is often self-limiting, requiring no medical treatment. As much as 90% of anterior nosebleeds occur in an area called the Kiesselbach’s plexus, which is a network of blood vessels that supply the nasal septum. Whereas posterior nosebleeds originate from the back of the nasal passage, near the throat. It is less common but is more dangerous as it can lead to significant bleeding. Most cases of posterior nosebleeds require hospital admissions and surgical interventions. Fortunately, children do not usually get posterior nosebleeds.
So what causes nosebleeds and giant blood clots?
Giant blood clots happen when nosebleeds remain stuck in the nose. Anterior nosebleeds are almost always caused by trauma or injury to the nasal mucosa. The most common cause is vigorous nose picking as the action of scratching and poking can injure the mucosa which is full of blood vessels. Blunt facial trauma like falling on the face or being punched at the face easily injures the nose and causes nosebleeds. Besides, nosebleeds occur when the nasal mucosa is irritated by dry or cold air. This is especially prominent during cold seasons or spending long hours in centrally-heated rooms that are not humidified. Occasionally, people get nosebleeds due to allergies or common cold. On top of the inflamed nasal mucosa, the act of sneezing may further injure and cause bleeding. Patients with allergy rhinitis who used steroidal nasal sprays frequently may also have nosebleeds because steroids make mucosal lining thin and fragile. On the other hand, bleeding that comes with pus discharge particularly in children might suggest the presence of foreign body stuck in the nose. Tissue excoriation and subsequent septal perforation occur in chronic cocaine use, resulting in anterior nosebleeds.
Less commonly, nosebleeds are caused by serious diseases such as bleeding disorders, abnormal blood vessels or cancers. For example, patients diagnosed with hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome), familial blood disorders, platelet disorders, von Willebrand disease and hemophilia are more prone to have nosebleeds regardless of the source of bleeding. Meanwhile, abnormal blood vessels like an aneurysm of the carotid artery can cause recurrent or severe posterior nosebleeds. Most often this bleeding occurs suddenly and requires emergency medical attention. Nosebleeds are also one of the common symptoms of certain cancers, namely squamous cell carcinoma, adenoid cystic carcinoma, melanoma and inverted papilloma. Chinese or southeastern origin patients should also be checked for nasopharyngeal cancers when presented with nosebleeds.
Giant blood clots and nosebleeds can also be a result of medications that prevent blood clotting like anticoagulants and antiplatelets. Notify your doctor if you have nosebleeds while on warfarin, dabigatran, rivaroxaban, apixaban, edoxaban, fondaparinux or clopidogrel. The evidence of nosebleeds due to daily aspirin use or hypertension remains uncertain. Lastly, a study showed that alcohol may increase the risk of nosebleeds.
Seek emergency medical care if the bleeding is:
- massive, recurrent, does not stop
- occurs after a face injury or surgery
- when taking anticoagulants or antiplatelets
- comes with other symptoms (chest pain, difficulty breathing, fainting or tiredness)