Increased Epistaxis with Use of Ezetimibe/Simvastatin

Could statins exert a protective effect on epistaxis of systemic origin?

Epistaxis, that is a relatively frequent occurrence of hemorrhage from the nose, is reported in up to 60% of the population with peak incidences in subjects under the age of ten ("essential" epistaxis, usually linked to an altered vasomotor regulation) and, with even greater entity, over the age of 60. The cause of nosebleeds can generally be divided into two categories, local and systemic factors, although it should be remembered that a significant number of nosebleeds occur with no obvious cause. Actually, according to the common observation the epistaxis prone subject is an elderly with hypertension associated to some degree of vascular alteration. The statins essentially exert a competitive inhibition of 3-hydroxy-3 methyl glutaryl coenzyme A (HMG-CoA) reductase that results in cholesterol synthesis inhibition. In the last years, however, there has been a growing evidence that these drugs exert a number of vascular actions that are independent of lipid lowering and result in a vasoprotective effect. Due to their favourable influence on the vascular wall, and the consequent possible modulatory effect on blood pressure, a possible utility of statins in preventing many cases of nosebleed is hypothesized, to our knowledge for the first time.