Epistaxis classification

Epistaxis may be classified according to the anatomical origin of the bleeding into 2 groups: anterior and posterior. It can also be further classified into primary (if idiopathic) or secondary (if there is a known cause) and acute or chronic.

Epistaxis can be classified into anterior and posterior based upon the anatomical source of bleeding^[1]

Anterior epistaxis:

• Anterior epistaxis is more common, and source of this bleeding is usually Kiesselbach’s plexus.^[2]
• Anterior epistaxis is easier to control with nasal compression, nasal packing and cautery.

Posterior-epistaxis:

• Posterior bleeding is less common and harder to stop, and source of this bleeding is usually Woodruff’s plexus.
• Woodruff’s plexus is formed by vessels that are branches of the external carotid artery, thus, when it bleeds, it is usually much more severe than bleeding from Kiesselbach plexus’ bleeding.^[2]
• Bleeding from this plexus may cause aspiration and show bleeding with coughing and hemoptysis.
• This type of bleeding is more common in patients taking anticoagulants or hypertension.^[3]

• Acute epistaxis: as the name implies, it is a “de novo” bleeding.

• Chronic epistaxis : it is characterized by intermittent bleeding, that persists through a period of time.

• Primary: it is classified as primary if the source of the bleeding isn’t known.

• Secondary: it is classified as secondary if the bleeding is caused by another disease process (trauma, anticoagulants, arterial malformation).

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