Epistaxis in horses refers to the occurrence of bleeding from the nostrils, a condition that can arise from various underlying causes. It may result from trauma, infections, neoplasia, or diseases affecting the respiratory tract. This condition can vary in severity and may be indicative of localized issues or systemic health concerns. In horses, common causes of epistaxis include exercise-induced pulmonary hemorrhage (EIPH), nasal or sinus infections, and guttural pouch mycosis. Veterinary evaluation is often necessary to determine the source and cause of the bleeding. This page compiles peer-reviewed research studies and scholarly articles that explore the etiology, diagnosis, and management of epistaxis in equine patients.
Massie SL, Léguillette R.Barrel racing involves sprinting through a cloverleaf pattern in under 20 s. The prevalence of upper airway obstructions (UAO) in barrel racers is unknown, thus a retrospective analysis of 164 client-owned horses referred for overground endoscopy (OGE) between 2014 and 2022 was performed. Referring complaints included respiratory noise, cough, epistaxis, behaviour (owner reported stress/anxiety, refusal to enter arena, excessive head shaking), and/or poor performance. Horses performed a standardized exercise test with low and high-speed components. Videoendoscopic recordings were systematical...
Sugiyama F, Takahashi Y, Nomura M, Ebisuda Y, Mukai K, Yoshida T.We investigated the risk factors for epistaxis in Japanese flat races over a 20-year period. The veterinary records of horses identified as having epistaxis by endoscopy on the race day, and the official racing records of all flat races from April to September between 2001 and 2020, were reviewed. The racecourses (n = 10), surface type, surface condition, race class, race distance, race year, sex, age, two training centers, ambient temperature, and body weight on race days were assessed using multivariable logistic regression (p < 0.05). Of 475,709 race starts, 616 (1.30 cases per 1000 starts;...
Hlokwe TM, Sutton D, Page P, Michel AL.Tuberculosis caused by Mycobacterium bovis (M. bovis) is very uncommon in horses worldwide. Methods: In the current study, an eight-year-old male Thoroughbred in good body condition was admitted to the Equine Clinic at the Onderstepoort Veterinary Academic Hospital in 2005 due to bilateral epistaxis accompanied by coughing. Routine examinations were conducted to determine the cause of the condition. Endoscopic examination revealed the major source of the epistaxis as the trachea, whereas thoracic radiography indicated the presence of a primary pulmonary mass. M. bovis was isolated from a bronc...
Cousty M, Tricaud C, De Beauregard T, Picandet V, Bizon-Mercier C, Tessier C.The objective of the study was to evaluate the effect of ligation of the ipsilateral common carotid artery (CCA) combined with various antimycotic treatments for the prevention of epistaxis in horses with guttural pouch mycosis. For each case, ipsilateral ligation of the CCA was performed, followed by application of various topical medications under endoscopic guidance. Frequency and number of treatments, outcome and recurrence of haemorrhage were retrospectively recorded. Twenty-four horses were included. Topical medication was administered by detachment of the diphtheric membrane and sprayin...
McClellan NR, Mudge MC, Scansen BA, Jung SS, Russell D.To describe successful transarterial coil embolization of a palatine artery pseudoaneurysm that extended into the caudal maxillary sinus of a gelding. Methods: Clinical report. Methods: A 24-year-old Morgan gelding with right-sided epistaxis. Methods: The right maxillary sinus was imaged by radiography, computed tomography, and sinoscopy. Angiography was performed to locate the source of bleeding, and transarterial coil embolization of a right palatine artery pseudoaneurysm was performed. Results: There was some mucoid nasal discharge and an intermittent cough postoperatively. No epistaxis was...
Langford JL, Thomson PC, Knight PK.To profile Thoroughbreds that incurred a ban under Australian Rule of Racing 53A on New South Wales racetracks between August 1999 and July 2008, determine the effect on their careers and identify the factors that predict whether these horses would race again or experience a recurrence of epistaxis. Methods: Differences between horses that did or did not return to racing and did or did not suffer recurrent epistaxis were determined. Backwards stepwise logistic regression was used to identify variables predicting a return to racing and recurrence of epistaxis. Results: The mean (± SD) age at t...
Sanz MG, Wills TB, Christopherson P, Hines MT.A 17-year-old Peruvian Paso mare was evaluated for bilateral epistaxis that had been present for at least 3 years. The mare had mild anemia, platelet count within the reference interval, unremarkable coagulation times, and a negative Coggins test. On endoscopic examination, structural abnormalities were not observed in the nasal cavities, pharynx, larynx, trachea, or either guttural pouch, but petechiation was noted in the nasal mucosa. Additional tests revealed prolonged cutaneous bleeding time, normal concentration of von Willebrand factor antigen, an abnormal clot retraction test, and failu...
Weideman H, Schoeman SJ, Jordaan GF.This study was carried out to estimate the heritability of liability to epistaxis in the southern African Thoroughbred population. Data of all horses that suffered epistaxis while racing in southern Africa and Mauritius from 1986 to 2002 and involving 1252 bleeders were analysed. Pedigree data covering the period 1960-1986 was used as required to calculate the incidence of bleeding amongst ancestors of the post-1986 era. Only pedigrees of horses that raced were included in this study as it was not possible to predict whether non-runners would have bled had they raced. Consequently all non-runn...
Schumacher J, Dean P, Welch B.Unilateral epistaxis in 2 horses was caused by inflammation of the distal portion of the lacrimal system. The origin of epistaxis was identified during physical examination by observing hemorrhage emanating from the nasal opening of the nasolacrimal duct. Dacryohemorrhea caused by bacterial infection was successfully treated with antibacterial drugs administered systemically and instilled into the lacrimal system.
Church S, Wyn-Jones G, Parks AH, Ritchie HE.Seventeen cases of guttural pouch mycosis (including two bilaterally affected cases) were diagnosed in a three year period. The presenting signs were, in order of frequency, epistaxis at rest, nasal catarrh, pharyngeal paralysis, ipsilateral laryngeal hemiplegia, swelling of the submandibular/parotid region, extension of the head and neck and dyspnoea. Ligation of the origin of the internal carotid and occipital arteries was attempted in 10 of the cases exhibiting epistaxis. Bilateral ligation was performed on one animal with an untoward sequelae. Where surgery was successfully completed furth...
Smith KM, Barber SM.A two year old Thoroughbred gelding, presented with guttural pouch hemorrhage, had the internal and external carotid arteries ligated. Guttural pouch mycosis was detected on endoscopic examination. After one month of topical antifungal therapy, the horse was returned and euthanized because of recurrent epistaxis. A bacterial infection of the guttural pouch with associated ulceration and hemorrhage from the maxillary artery was found at necropsy.A two year old grade gelding had ulceration and hemorrhage from the external carotid artery. Utilizing balloon-tipped catheters and arterial ligation, ...
Vrins A, Carlson G, Feldman B.Warfarin or dicoumarol prevents the production of functional clotting factors II, VII, IX and X. Navicular disease and thrombophlebitis are examples of equine thrombotic diseases in which warfarin has been used therapeutically. The initiation of anticoagulant therapy is relatively simple but attending veterinarians must be aware of the potential risks in order to minimize them. These risks include epistaxis, bleeding into the gastrointestinal tract and at the venipuncture site, and increased susceptibility to hematoma formation following local trauma. Vitamin K, especially vitamin K(1) is a sw...
Etherington WG, Vasey JR, Horney FD.Two cases of ethmoid hematoma of the equine are reported. Clinically both horses had intermittent unilateral epistaxis unassociated with exercise. In one horse, diagnosis was based on the use of an endoscope for visualization and for biopsy of a mass associated with the ethmoid turbinates. In the other horse, exploratory trephination of the posterior maxillary sinus was necessary to obtain a diagnostic biopsy specimen. Radiography was helpful in the diagnosis of one case. Surgical removal of the mass was attempted in one case. Histological examination of the biopsies was the single most defini...
Freeman DE, Donawick WJ.An intravascular procedure was used to occlude the internal carotid artery of two horses with epistaxis caused by guttural pouch mycosis. In each horse, the affected internal carotid artery was ligated close to its origin. A balloon-tipped catheter was introduced into the artery distal to the ligature, and its tip was advanced beyond the site of infection. The balloon was then inflated so that the infected segment of artery was isolated from the cerebral vascular system. The catheters were removed at 14 and 51 days, and both horses were returned to training and racing. Neither horse had furthe...
Sanz MG, Wills TB, Christopherson P, Hines MT.A 17-year-old Peruvian Paso mare was evaluated for bilateral epistaxis that had been present for at least 3 years. The mare had mild anemia, platelet count within the reference interval, unremarkable coagulation times, and a negative Coggins test. On endoscopic examination, structural abnormalities were not observed in the nasal cavities, pharynx, larynx, trachea, or either guttural pouch, but petechiation was noted in the nasal mucosa. Additional tests revealed prolonged cutaneous bleeding time, normal concentration of von Willebrand factor antigen, an abnormal clot retraction test, and failu...
Smith KM, Barber SM.A two year old Thoroughbred gelding, presented with guttural pouch hemorrhage, had the internal and external carotid arteries ligated. Guttural pouch mycosis was detected on endoscopic examination. After one month of topical antifungal therapy, the horse was returned and euthanized because of recurrent epistaxis. A bacterial infection of the guttural pouch with associated ulceration and hemorrhage from the maxillary artery was found at necropsy.A two year old grade gelding had ulceration and hemorrhage from the external carotid artery. Utilizing balloon-tipped catheters and arterial ligation, ...
Langford JL, Thomson PC, Knight PK.To profile Thoroughbreds that incurred a ban under Australian Rule of Racing 53A on New South Wales racetracks between August 1999 and July 2008, determine the effect on their careers and identify the factors that predict whether these horses would race again or experience a recurrence of epistaxis. Methods: Differences between horses that did or did not return to racing and did or did not suffer recurrent epistaxis were determined. Backwards stepwise logistic regression was used to identify variables predicting a return to racing and recurrence of epistaxis. Results: The mean (± SD) age at t...
Vrins A, Carlson G, Feldman B.Warfarin or dicoumarol prevents the production of functional clotting factors II, VII, IX and X. Navicular disease and thrombophlebitis are examples of equine thrombotic diseases in which warfarin has been used therapeutically. The initiation of anticoagulant therapy is relatively simple but attending veterinarians must be aware of the potential risks in order to minimize them. These risks include epistaxis, bleeding into the gastrointestinal tract and at the venipuncture site, and increased susceptibility to hematoma formation following local trauma. Vitamin K, especially vitamin K(1) is a sw...
Cousty M, Tricaud C, De Beauregard T, Picandet V, Bizon-Mercier C, Tessier C.The objective of the study was to evaluate the effect of ligation of the ipsilateral common carotid artery (CCA) combined with various antimycotic treatments for the prevention of epistaxis in horses with guttural pouch mycosis. For each case, ipsilateral ligation of the CCA was performed, followed by application of various topical medications under endoscopic guidance. Frequency and number of treatments, outcome and recurrence of haemorrhage were retrospectively recorded. Twenty-four horses were included. Topical medication was administered by detachment of the diphtheric membrane and sprayin...
Hlokwe TM, Sutton D, Page P, Michel AL.Tuberculosis caused by Mycobacterium bovis (M. bovis) is very uncommon in horses worldwide. Methods: In the current study, an eight-year-old male Thoroughbred in good body condition was admitted to the Equine Clinic at the Onderstepoort Veterinary Academic Hospital in 2005 due to bilateral epistaxis accompanied by coughing. Routine examinations were conducted to determine the cause of the condition. Endoscopic examination revealed the major source of the epistaxis as the trachea, whereas thoracic radiography indicated the presence of a primary pulmonary mass. M. bovis was isolated from a bronc...
Schumacher J, Dean P, Welch B.Unilateral epistaxis in 2 horses was caused by inflammation of the distal portion of the lacrimal system. The origin of epistaxis was identified during physical examination by observing hemorrhage emanating from the nasal opening of the nasolacrimal duct. Dacryohemorrhea caused by bacterial infection was successfully treated with antibacterial drugs administered systemically and instilled into the lacrimal system.
McClellan NR, Mudge MC, Scansen BA, Jung SS, Russell D.To describe successful transarterial coil embolization of a palatine artery pseudoaneurysm that extended into the caudal maxillary sinus of a gelding. Methods: Clinical report. Methods: A 24-year-old Morgan gelding with right-sided epistaxis. Methods: The right maxillary sinus was imaged by radiography, computed tomography, and sinoscopy. Angiography was performed to locate the source of bleeding, and transarterial coil embolization of a right palatine artery pseudoaneurysm was performed. Results: There was some mucoid nasal discharge and an intermittent cough postoperatively. No epistaxis was...
Weideman H, Schoeman SJ, Jordaan GF.This study was carried out to estimate the heritability of liability to epistaxis in the southern African Thoroughbred population. Data of all horses that suffered epistaxis while racing in southern Africa and Mauritius from 1986 to 2002 and involving 1252 bleeders were analysed. Pedigree data covering the period 1960-1986 was used as required to calculate the incidence of bleeding amongst ancestors of the post-1986 era. Only pedigrees of horses that raced were included in this study as it was not possible to predict whether non-runners would have bled had they raced. Consequently all non-runn...
Sugiyama F, Takahashi Y, Nomura M, Ebisuda Y, Mukai K, Yoshida T.We investigated the risk factors for epistaxis in Japanese flat races over a 20-year period. The veterinary records of horses identified as having epistaxis by endoscopy on the race day, and the official racing records of all flat races from April to September between 2001 and 2020, were reviewed. The racecourses (n = 10), surface type, surface condition, race class, race distance, race year, sex, age, two training centers, ambient temperature, and body weight on race days were assessed using multivariable logistic regression (p < 0.05). Of 475,709 race starts, 616 (1.30 cases per 1000 starts;...
Etherington WG, Vasey JR, Horney FD.Two cases of ethmoid hematoma of the equine are reported. Clinically both horses had intermittent unilateral epistaxis unassociated with exercise. In one horse, diagnosis was based on the use of an endoscope for visualization and for biopsy of a mass associated with the ethmoid turbinates. In the other horse, exploratory trephination of the posterior maxillary sinus was necessary to obtain a diagnostic biopsy specimen. Radiography was helpful in the diagnosis of one case. Surgical removal of the mass was attempted in one case. Histological examination of the biopsies was the single most defini...
Freeman DE, Donawick WJ.An intravascular procedure was used to occlude the internal carotid artery of two horses with epistaxis caused by guttural pouch mycosis. In each horse, the affected internal carotid artery was ligated close to its origin. A balloon-tipped catheter was introduced into the artery distal to the ligature, and its tip was advanced beyond the site of infection. The balloon was then inflated so that the infected segment of artery was isolated from the cerebral vascular system. The catheters were removed at 14 and 51 days, and both horses were returned to training and racing. Neither horse had furthe...
Church S, Wyn-Jones G, Parks AH, Ritchie HE.Seventeen cases of guttural pouch mycosis (including two bilaterally affected cases) were diagnosed in a three year period. The presenting signs were, in order of frequency, epistaxis at rest, nasal catarrh, pharyngeal paralysis, ipsilateral laryngeal hemiplegia, swelling of the submandibular/parotid region, extension of the head and neck and dyspnoea. Ligation of the origin of the internal carotid and occipital arteries was attempted in 10 of the cases exhibiting epistaxis. Bilateral ligation was performed on one animal with an untoward sequelae. Where surgery was successfully completed furth...
Massie SL, Léguillette R.Barrel racing involves sprinting through a cloverleaf pattern in under 20 s. The prevalence of upper airway obstructions (UAO) in barrel racers is unknown, thus a retrospective analysis of 164 client-owned horses referred for overground endoscopy (OGE) between 2014 and 2022 was performed. Referring complaints included respiratory noise, cough, epistaxis, behaviour (owner reported stress/anxiety, refusal to enter arena, excessive head shaking), and/or poor performance. Horses performed a standardized exercise test with low and high-speed components. Videoendoscopic recordings were systematical...
